International journal of thyroidology

Korean Thyroid Association (대한갑상선학회)
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Efficacy of Intraoperative Neural Monitoring (IONM) in Thyroid Surgery: the Learning Curve

갑상선 수술에서 수술 중 신경 감시의 효용성: 학습곡선을 중심으로

  • Kwak, Min Kyu (Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University College of Medicine) ;
  • Lee, Song Jae (Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University College of Medicine) ;
  • Song, Chang Myeon (Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University College of Medicine) ;
  • Ji, Yong Bae (Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University College of Medicine) ;
  • Tae, Kyung (Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University College of Medicine)
  • 곽민규 (한양대학교 의과대학 이비인후-두경부외과학교실) ;
  • 이송재 (한양대학교 의과대학 이비인후-두경부외과학교실) ;
  • 송창면 (한양대학교 의과대학 이비인후-두경부외과학교실) ;
  • 지용배 (한양대학교 의과대학 이비인후-두경부외과학교실) ;
  • 태경 (한양대학교 의과대학 이비인후-두경부외과학교실)
  • Received : 2018.10.15
  • Accepted : 2018.10.29
  • Published : 2018.11.30
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Abstract

Background and Objectives: Intraoperative neural monitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery has been employed worldwide to identify and preserve the nerve as an adjunct to visual identification. The aims of this study was to evaluate the efficacy of IONM and difficulties in the learning curve. Materials and Methods: We studied 63 patients who underwent thyroidectomy with IONM during last 2 years. The standard IONM procedure was performed using NIM 3.0 or C2 Nerve Monitoring System. Patients were divided into two chronological groups based on the success rate of IONM (33 cases in the early period and 30 cases in the late period), and the outcomes were compared between the two groups. Results: Of 63 patients, 32 underwent total thyroidectomy and 31 thyroid lobectomy. Failure of IONM occurred in 9 cases: 8 cases in the early period and 1 case in the late period. Loss of signal occurred in 8 nerves of 82 nerves at risk. The positive predictive value increased from 16.7% in the early period to 50% in the late period. The mean amplitude of the late period was higher than that of the early period (p<0.001). Conclusion: IONM in thyroid surgery is effective to preserve the RLN and to predict postoperative nerve function. However, failure of IONM and high false positive rate can occur in the learning curve, and the learning curve was about 30 cases based on the results of this study.

Keywords

References

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