Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Otolaryngology, School of Post-Baccalaureate Medicine and School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Otolaryngol Head Neck Surg. 2024 Jan-Dec;53:19160216241265684. doi: 10.1177/19160216241265684.
The aim of this study is to describe the management and associated follow-up strategies adopted by thyroid surgeons with different surgical volumes when loss of signal (LOS) occurred on the first side of planned bilateral thyroid surgery, and to further define the consensus on intraoperative neuromonitoring (IONM) applications.
The International Neural Monitoring Study Group (INMSG) web-based survey was sent to 950 thyroid surgeons worldwide. The survey included information on the participants, IONM team/equipment/procedure, intraoperative/postoperative management of LOS, and management of LOS on the first side of thyroidectomy for benign and malignant disease.
Out of 950, 318 (33.5%) respondents completed the survey. Subgroup analyses were performed based on thyroid surgery volume: <50 cases/year (n = 108, 34%); 50 to 100 cases/year (n = 69, 22%); and >100 cases/year (n = 141, 44.3%). High-volume surgeons were significantly ( < .05) more likely to perform the standard procedures (L1-V1-R1-S1-S2-R2-V2-L2), to differentiate true/false LOS, and to verify the LOS lesion/injury type. When LOS occurs, most surgeons arrange otolaryngologists or speech consultation. When first-side LOS occurs, not all respondents decided to perform stage contralateral surgery, especially for malignant patients with severe disease (eg, extrathyroid invasion and poorly differentiated thyroid cancer).
Respondents felt that IONM was optimized when conducted under a collaborative team-based approach, and completed IONM standard procedures and management algorithm for LOS, especially those with high volume. In cases of first-site LOS, surgeons can determine the optimal management of disease-related, patient-related, and surgical factors. Surgeons need additional education on LOS management standards and guidelines to master their decision-making process involving the application of IONM.
本研究旨在描述不同手术量的甲状腺外科医生在计划双侧甲状腺手术的第一侧出现信号丢失（LOS）时所采用的管理和相关随访策略，并进一步定义术中神经监测（IONM）应用的共识。
国际神经监测研究组（INMSG）的在线调查发送给了全球 950 名甲状腺外科医生。该调查包括了参与者、IONM 团队/设备/程序、LOS 的术中/术后管理以及良性和恶性疾病甲状腺切除术第一侧 LOS 的管理等信息。
在 950 名受访者中，有 318 名（33.5%）完成了调查。根据甲状腺手术量进行了亚组分析：<50 例/年（n=108，34%）；50-100 例/年（n=69，22%）；>100 例/年（n=141，44.3%）。高手术量的外科医生更有可能（ < .05）执行标准程序（L1-V1-R1-S1-S2-R2-V2-L2），区分真假 LOS，并验证 LOS 病变/损伤类型。当 LOS 发生时，大多数外科医生会安排耳鼻喉科医生或言语咨询。当第一侧 LOS 发生时，并非所有受访者都决定进行对侧手术分期，特别是对于恶性疾病严重的患者（例如甲状腺外侵犯和低分化甲状腺癌）。
受访者认为，IONM 采用协作团队方法进行时效果最佳，并完成了 LOS 的 IONM 标准程序和管理算法，尤其是那些高容量的外科医生。在第一侧 LOS 的情况下，外科医生可以根据疾病相关、患者相关和手术相关因素确定最佳的管理方案。外科医生需要接受更多关于 LOS 管理标准和指南的教育，以掌握他们在应用 IONM 时的决策过程。
