Abstract
Continuous and intermittent intraoperative nerve monitoring (IONM) has become an important asset for endocrine surgeons over the past few decades. The ability to determine neurophysiologic integrity of the recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) on top of identification and meticulous dissection of the nerve in the surgical field, has allowed for advances in technology and improved outcomes when it comes to prevention of vocal fold immobility. This article aims to compare in review continuous and intermittent nerve monitoring (CIONM, IIONM), as well as review the current paradigms of their use. This article will also discuss the future of intraoperative nerve monitoring technologies in scarless thyroid surgery and percutaneous approaches to thyroid pathology in form of radiofrequency ablation (RFA).
Highlights
The largest complication, and one with the most medio-legal implications during thyroid surgery, is injury to the recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN), during thyroid and parathyroid surgery
The use of IIONM and CIONM has been established with the International Neural Monitoring Study Group (INMSG), a multidisciplinary international group of surgeons and researchers, who published a comprehensive guideline on the technology [13]
Both of these intraoperative nerve monitoring techniques are being evaluated in a new arena, one that concerns the evolution of surgical procedures surrounding thyroid and parathyroid disease, from transcervical to endoscopic and robotic surgical approaches
Summary
The largest complication, and one with the most medio-legal implications during thyroid surgery, is injury to the recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN), during thyroid and parathyroid surgery. The use of IIONM and CIONM has been established with the International Neural Monitoring Study Group (INMSG), a multidisciplinary international group of surgeons and researchers, who published a comprehensive guideline on the technology [13] Both of these intraoperative nerve monitoring techniques are being evaluated in a new arena, one that concerns the evolution of surgical procedures surrounding thyroid and parathyroid disease, from transcervical to endoscopic and robotic surgical approaches. Both of these techniques employ recording electromyographic signals from contraction of the vocal fold adductor muscles in response to stimulation of the RLN or vagus nerves using surface electrodes attached to an endotracheal tube (EMG-ETT). Possible complications associated with the use of the technology have been outlined by the INMSG, with more complications associated with CIONM for reasons listed above [13, 36]
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