The Technique of Intraoperative Neuromonitoring in Thyroid Surgery

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Publication:

Surgical Technology International XIX - Surgical Overview

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Author(s)

Gianlorenzo Dionigi, M.D., F.A.C.S.
Associate Professor of Surgery
Director, Endocrine Surgery Research Center

Alessandro Bacuzzi, M.D.
Endocrine Surgery Research Center

Luigi Boni, M.D., F.A.C.S.
Associate Professor of Surgery
Endocrine Surgery Research Center

Francesca Rovera, M.D.
Endocrine Surgery Research Center

Stefano Rausei, M.D.
Endocrine Surgery Research Center

Francesco Frattini, M.D.
Endocrine Surgery Research Center

Renzo Dionigi, F.A.C.S., F.R.C.S. (Hon. Edin.)
Full Professor of Surgery
Endocrine Surgery Research Center
Director

Department of Surgical Sciences, University of Insubria
Varese-Como, Italy

Abstract

Recurrent laryngeal nerve (RLN) palsy during thyroidectomy is associated with multiple risk factors as patient- and surgeon-related bailiff. The risk is greater for thyroid cancer, Graves' disease, re-operation, and mediastinal goiter in less experienced centers and in patients in whom the RLN could not be identified during operation. Anatomical landmarks exist to identify RLN. Nevertheless, transient and permanent RLN injuries still exist. Intraoperative neuromonitoring (IONM) has been introduced to facilitate identification and verify functional integrity of the RLN in thyroid surgery. In this chapter, we present relevant medical literature and personal experience on thyroid surgery with IONM. Technical, medical, and legal aspects of monitoring are discussed.