Gianlorenzo Dionigi1, Gianluca Donatini2, Luigi Boni1, Stefano Rausei1, Francesca Rovera1, Maria Laura Tanda3, Hoon Yub Kim4, Feng-Yu Chiang5, Che-Wei Wu5, Alberto Mangano1, Francesco Rulli6, Piero F Alesina7, Renzo Dionigi1. 1. Division of General Surgery, Department of Surgical Sciences, University of Insubria, Varese-Como, Italy. 2. Chirurgia Generale delle Apuane, Asl 1 Toscana, Italy. 3. Department of Clinical Medicine, Endocrinology, University of Insubria, Varese-Como, Italy. 4. Department of Surgery, Korea University College of Medicine, Seoul, Korea. 5. Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan. 6. Department of Surgery, University Hospital of Tor Vergata, Rome, Italy. 7. Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Essen, Germany.
Abstract
BACKGROUND AND PURPOSE: Intraoperative neuromonitoring (IONM) contributes in several ways to recurrent laryngeal nerve (RLN) protection. Notwithstanding these advantages, surgeons must be aware that the current, intermittent, mode of IONM (I-IONM) has relevant limitations. To overcome these I-IONM limitations, a continuous IONM (C-IONM) technology has been proposed. METHODS: A PubMed indexed literature review of the current limitations of I-IONM is presented and a commentary about C-IONM is provided presenting the preliminary results of research on this topic. MAIN FINDINGS: I-IONM, despite the advantages it produces, presents some important limitations; to overcome these drawbacks a C-IONM technology has been introduced. CONCLUSIONS: RLN traction injury is still the most common cause of RLN injury and is difficult to avoid with the application of I-IONM in thyroid surgery. C-IONM is useful to prevent the imminent traction injury by detecting progressive decreases in electromyographic amplitude combined with progressive latency increases. C-IONM seems to be a technological improvement. Likely, C-IONM by vagal nerve stimulation should enhance the standardization process, RLN intraoperative information, documentation, protection, training, and research in modern thyroid surgery. Although C-IONM is a promising technology at the cutting edge of research in thyroid surgery, we need more studies to assess in an evidence-based way all its advantages.
BACKGROUND AND PURPOSE: Intraoperative neuromonitoring (IONM) contributes in several ways to recurrent laryngeal nerve (RLN) protection. Notwithstanding these advantages, surgeons must be aware that the current, intermittent, mode of IONM (I-IONM) has relevant limitations. To overcome these I-IONM limitations, a continuous IONM (C-IONM) technology has been proposed. METHODS: A PubMed indexed literature review of the current limitations of I-IONM is presented and a commentary about C-IONM is provided presenting the preliminary results of research on this topic. MAIN FINDINGS: I-IONM, despite the advantages it produces, presents some important limitations; to overcome these drawbacks a C-IONM technology has been introduced. CONCLUSIONS: RLN traction injury is still the most common cause of RLN injury and is difficult to avoid with the application of I-IONM in thyroid surgery. C-IONM is useful to prevent the imminent traction injury by detecting progressive decreases in electromyographic amplitude combined with progressive latency increases. C-IONM seems to be a technological improvement. Likely, C-IONM by vagal nerve stimulation should enhance the standardization process, RLN intraoperative information, documentation, protection, training, and research in modern thyroid surgery. Although C-IONM is a promising technology at the cutting edge of research in thyroid surgery, we need more studies to assess in an evidence-based way all its advantages.
Authors: Gianlorenzo Dionigi; Davide Lombardi; Celestino Pio Lombardi; Paolo Carcoforo; Marco Boniardi; Nadia Innaro; Maria Grazia Chiofalo; Ottavio Cavicchi; Antonio Biondi; Francesco Basile; Angelo Zaccaroni; Alberto Mangano; Andrea Leotta; Matteo Lavazza; Pietro Giorgio Calò; Angelo Nicolosi; Paolo Castelnuovo; Piero Nicolai; Luciano Pezzullo; Giorgio De Toma; Rocco Bellantone; Rosario Sacco Journal: Updates Surg Date: 2014-12-03
Authors: Rick Schneider; Andreas Machens; Michael Bucher; Christoph Raspé; Konstantin Heinroth; Henning Dralle Journal: Langenbecks Arch Surg Date: 2016-04-30 Impact factor: 3.445