Evidence and recommendation. Intermitent neuromonitoring in thyroid surgery is usefulness for reduction of recurrent nerve palsy?
Abstract Introduction and objective: Clinical Question. In a patient with thyroid disease [patient], submitted to thyroidectomy [intervention], the use of neuromonitoring against the single visual identification of recurrent laryngeal nerve (RLN) [comparison], offers advantages? [result]. Material and Methods: Literature review in PubMed, Scopus and Cochrane Library data descriptors and search strategy: (((((((laryngeal) OR larynx)) AND nerve) AND monitoring) AND thyroidectomy)) AND meta-analysis. 10 items in English or Spanish of which 7 were selected for the qualitative study were obtained. Results: Level of evidence. Evidence for the lower incidence of transient unilateral paralysis in patients with neuromonitoring is moderate-high. Evidence on the lower incidence of permanent unilateral paralysis of RLN with NM is low. Evidence on the lower incidence of bilateral paralysis of RLN with neuromonitoring is low. Conclusions: Recommendation. Concerning the reduction of transient paralysis of the RLN the recommendation of the use of neuromonitoring in thyroid surgery is strongly in favor. Regarding permanent paralysis recommendation is weak in favor (no recommendation against). Regarding prevention of bilateral laryngeal paralysis recommendation for weak. The decision to use NM cannot be based on the incidence of RLN paralysis.
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Henry LR, Abad JD, Stojadinovic A. The voice, not the nerve, is the functionally relevant endpoint. J Surg Oncol. 2012;106(8):1005-6. https://doi.org/10.1002/jso.23208
Higgins TS, Gupta R, Ketcham AS, Sataloff RT, Wadsworth JT, Sinacori JT. Recurrent laryngeal nerve monitoring versus identification alone onpost-thyroidectomy true vocal fold palsy: a meta-analysis. Laryngoscope. 2011;121(5):1009-17. https://doi.org/10.1002/lary.21578
Ochoa-Sangrador C. Evidencia y recomendación. Rev. ORL. 2016;7(2):67-71. Disponible en: http://dx.doi.org/10.14201/orl201672.14019. [Citado 9 de julio de 2016]. https://doi.org/10.14201/orl201672.14019
Pardal-Refoyo JL, Ochoa-Sangrador C, Cuello-Azcárate JJ, Martín-Almendra MA. Rev Soc Otorrinolaringol Castilla Leon Cantab La Rioja. Precisión de la neuromonitorización en cirugía tiroidea. 2013;4(23):175-93. Disponible en: http://hdl.handle.net/10366/124525. [Citado el 9 de julio de 2016].
Pardal-Refoyo JL, Ochoa-Sangrador C. Bilateral recurrent laryngeal nerve injury in total thyroidectomy with or without intraoperative neuromonitoring.S ystematic review and meta-analysis. Acta Otorrinolaringol Esp. 2016;67(2):66-74. https://doi.org/10.1016/j.otorri.2015.02.001
Pisanu A, Porceddu G, Podda M, Cois A, Uccheddu A. Systematic review with meta-analysis of studies comparing intraoperative neuromonitoring of recurrent laryngeal nerves versus visualization alone during thyroidectomy. J Surg Res. 2014;188(1):152-61 https://doi.org/10.1016/j.jss.2013.12.022
Riddell V. Thyroidectomy: prevention of bilateral recurrent nerve palsy. Results of identification of the nerve over 23 consecutive years (1946-69) with a description of an additional safety measure. Br J Surg. 1970;57(1):1-11. https://doi.org/10.1002/bjs.1800570102
Rulli F, Ambrogi V, Dionigi G, Amirhassankhani S, Mineo TC, Ottaviani F, et al. Meta-analysis of recurrent laryngeal nerve injury inthyroid surgery with or without intraoperative nerve monitoring. Acta Otorhinolaryngol Ital. 2014;34(4):223-9.
Sanabria A, Ramírez A, Kowalski LP, Silver CE, Shaha AR, Owen RP, et al. Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials. Eur Arch Otorhinolaryngol. 2013;270(8):2175-89 https://doi.org/10.1007/s00405-013-2557-2
Sanabria Á, Ramírez A. Economic analysis of routine neuromonitoring ofrecurrent laryngeal nerve in total thyroidectomy. Biomedica. 2015;35(3):363-71. https://doi.org/10.7705/biomedica.v35i3.2371
Zheng S, Xu Z, Wei Y, Zeng M, He J. Effect of intraoperative neuromonitoringon recurrent laryngeal nerve palsy rates after thyroid surgery--a meta-analysis. J Formos Med Assoc. 2013;112(8):463-72. https://doi.org/10.1016/j.jfma.2012.03.00
Higgins TS, Gupta R, Ketcham AS, Sataloff RT, Wadsworth JT, Sinacori JT. Recurrent laryngeal nerve monitoring versus identification alone onpost-thyroidectomy true vocal fold palsy: a meta-analysis. Laryngoscope. 2011;121(5):1009-17. https://doi.org/10.1002/lary.21578
Ochoa-Sangrador C. Evidencia y recomendación. Rev. ORL. 2016;7(2):67-71. Disponible en: http://dx.doi.org/10.14201/orl201672.14019. [Citado 9 de julio de 2016]. https://doi.org/10.14201/orl201672.14019
Pardal-Refoyo JL, Ochoa-Sangrador C, Cuello-Azcárate JJ, Martín-Almendra MA. Rev Soc Otorrinolaringol Castilla Leon Cantab La Rioja. Precisión de la neuromonitorización en cirugía tiroidea. 2013;4(23):175-93. Disponible en: http://hdl.handle.net/10366/124525. [Citado el 9 de julio de 2016].
Pardal-Refoyo JL, Ochoa-Sangrador C. Bilateral recurrent laryngeal nerve injury in total thyroidectomy with or without intraoperative neuromonitoring.S ystematic review and meta-analysis. Acta Otorrinolaringol Esp. 2016;67(2):66-74. https://doi.org/10.1016/j.otorri.2015.02.001
Pisanu A, Porceddu G, Podda M, Cois A, Uccheddu A. Systematic review with meta-analysis of studies comparing intraoperative neuromonitoring of recurrent laryngeal nerves versus visualization alone during thyroidectomy. J Surg Res. 2014;188(1):152-61 https://doi.org/10.1016/j.jss.2013.12.022
Riddell V. Thyroidectomy: prevention of bilateral recurrent nerve palsy. Results of identification of the nerve over 23 consecutive years (1946-69) with a description of an additional safety measure. Br J Surg. 1970;57(1):1-11. https://doi.org/10.1002/bjs.1800570102
Rulli F, Ambrogi V, Dionigi G, Amirhassankhani S, Mineo TC, Ottaviani F, et al. Meta-analysis of recurrent laryngeal nerve injury inthyroid surgery with or without intraoperative nerve monitoring. Acta Otorhinolaryngol Ital. 2014;34(4):223-9.
Sanabria A, Ramírez A, Kowalski LP, Silver CE, Shaha AR, Owen RP, et al. Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials. Eur Arch Otorhinolaryngol. 2013;270(8):2175-89 https://doi.org/10.1007/s00405-013-2557-2
Sanabria Á, Ramírez A. Economic analysis of routine neuromonitoring ofrecurrent laryngeal nerve in total thyroidectomy. Biomedica. 2015;35(3):363-71. https://doi.org/10.7705/biomedica.v35i3.2371
Zheng S, Xu Z, Wei Y, Zeng M, He J. Effect of intraoperative neuromonitoringon recurrent laryngeal nerve palsy rates after thyroid surgery--a meta-analysis. J Formos Med Assoc. 2013;112(8):463-72. https://doi.org/10.1016/j.jfma.2012.03.00
Pardal-Refoyo, J. L. (2017). Evidence and recommendation. Intermitent neuromonitoring in thyroid surgery is usefulness for reduction of recurrent nerve palsy?. Revista ORL, 8(1), 47–51. https://doi.org/10.14201/orl.14880
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