Open Total Thyroidectomy with Continuous Intraoperative Nerve Monitoring

Abstract

Introduction: Continuous intraoperative nerve monitoring (C-IONM) during thyroid surgery can be used to assess the recurrent laryngeal nerve (RLN) function and preventing unilateral and bilateral palsy. The main advantage of C-IONM using temporary implantable vagus electrode compared with the intermittent format (I-IONM) is the real-time monitoring of RLN integrity during thyroid mobilization and RLN dissection.1 Indeed, the I-IONM format using the handheld stimulation probe exposes the RLN to the risk of injury in between two stimulations. Therefore, the injury of the nerve can only be detected after the damage has already occurred, allowing to set to zero only bilateral RLN palsy by means of avoiding contralateral procedure (two-step surgery).2 In contrast, C-IONM provides the opportunity to perform the critical surgical actions necessary to avoid the impending RLN injury and enables to recover the RLN function after loss of signal, allowing to avoid even unilateral RLN palsy. Hereby we presented a video of a total thyroidectomy for a huge multinodular goiter performed with the help of C-IONM. Materials and Methods: A 54-year-old woman presented with a huge multinodular goiter. A total thyroidectomy performed with the help of C-IONM was planned. The surgical steps were illustrated and the anatomical structures identified. Results and Conclusions: C-IONM is a safe additional tool for thyroidectomy, which enables to perform the corrective maneuvers to avoid permanent nerve injury. If adequately used, it could prevent bilateral and unilateral RLN palsy. It results of great help in difficult cases, such as huge or recurrent multinodular goiter. No competing financial interests exist. Runtime of video: 7 mins 13 secs