Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany.
Br J Surg. 2012 Aug;99(8):1089-95. doi: 10.1002/bjs.8831. Epub 2012 Jun 14.
This study aimed to assess current use of recurrent laryngeal nerve monitoring (RLNM) for bilateral thyroid surgery in Germany. It explored the willingness of surgeons to change strategy after loss of signal (LOS) on the first side of resection.
Surgical departments in Germany equipped with nerve monitors were asked to complete a structured questionnaire, specifying the number of thyroidectomies done in 2010, and the frequencies of RLNM, vagal stimulation, and electromyographic (EMG) recording before and after thyroidectomy. They were also asked about the surgical plan for bilateral goitre after LOS on the first side of resection.
Based on manufacturers' sales data, 1119 (89·1 per cent) of 1256 surgical departments in Germany were equipped with nerve monitors in 2010. A total of 595 departments (53·2 per cent), accounting for approximately 75 per cent of all thyroidectomies in Germany during that year, returned a completed questionnaire. RLNM was used in 91·7-93·5 per cent of thyroidectomies, with the addition of routine vagal stimulation in 49·3 per cent before, and 73·8 per cent after resection. EMG responses to vagal stimulation were recorded in 54·8 per cent before, and 72·5 per cent after resection. Some 93·5 per cent of surgeons changed the resection plan for the other side in bilateral thyroid surgery after LOS had occurred on the first side.
RLNM is now the standard of care during thyroidectomy in Germany. After LOS on the first side of resection in bilateral goitre, more than 90 per cent of respondents declared their willingness to change the resection plan for the contralateral side to avoid the risk of bilateral recurrent laryngeal nerve palsy.
本研究旨在评估德国目前在双侧甲状腺手术中使用喉返神经监测（RLNM）的情况。探讨了在对侧切除时信号丢失（LOS）后，外科医生改变策略的意愿。
德国配备神经监测器的外科部门被要求完成一份结构化问卷，具体说明 2010 年进行的甲状腺切除术数量，以及 RLNM、迷走神经刺激和肌电图（EMG）记录的频率，分别在甲状腺切除前后。他们还被问及在对侧切除时发生 LOS 后双侧甲状腺肿的手术计划。
根据制造商的销售数据，德国共有 1256 个外科部门中，1119 个（89.1%）配备了神经监测器。2010 年，共有 595 个部门（53.2%）返回了一份完整的问卷，占当年德国所有甲状腺切除术的约 75%。91.7-93.5%的甲状腺切除术使用 RLNM，49.3%的手术在术前常规进行迷走神经刺激，73.8%的手术在术后进行。术前 54.8%和术后 72.5%的手术记录了迷走神经刺激的 EMG 反应。双侧甲状腺手术中，对侧切除计划在对侧 LOS 发生后，93.5%的外科医生改变了手术计划。
RLNM 现在是德国甲状腺切除术的标准护理。在双侧甲状腺肿对侧切除时发生 LOS 后，超过 90%的受访者表示愿意改变对侧切除计划，以避免双侧喉返神经麻痹的风险。
