부갑상선 절제술에 있어 반회후두신경의 수술 중 신경감시술의 임상적 의의

Abstract

Background and Objectives Intraoperative nerve monitoring (IONM) has been gaining acceptance as a formal practice of thyroid and parathyroid surgery. However, most studies of IONM for recurrent laryngeal nerve (RLN) primarily focused on thyroid surgery. In this study, we evaluated clinical implications of IONM solely in parathyroid surgery, by comparing results of parathyroidectomy in patients with or without IONM. Materials and Methods This study designed as a retrospective cohort study. Between 2010 and 2022, patients who underwent parathyroidectomy for the treatment of hyperparathyroidism were included. Patients were divided into the no IONM and IONM groups and compared clinicopathological and surgical parameters according to the use of IONM. Results A total of 107 patients involving 65 patients in the IONM group and 42 patients in the IONM group were included in the study. In the IONM group, proportion of surgical type of uni- and bilateral neck exploration was significantly higher in the IONM group than the no IONM group (35.7% vs. 6.2%, p<0.001). Rate of RLN identification during surgery was significantly higher in the IONM group than the no IONM group (81.0% vs. 43.1%, p<0.001). Operating time for minimal invasive/focused parathyroidectomy was significantly shorter in the IONM group than the no IONM group (61.8 min vs. 85.6 min, p<0.001). Vocal cord paralysis occurred only 1 case in each group without significant difference in the incidence. Conclusion Use of IONM would contribute to safe and faster parathyroidectomy, justifying its routine use in parathyroid surgery.