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Critical Appraisal

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Abstract

Over the last 20 years, technologies have been developed which have dramatically changed the field of surgery. While meticulous surgical technique and attention to detail remain the hallmarks of thyroid surgery, many surgeons have incorporated new technologies to enable them to perform thyroidectomy safely and faster. Intraoperative nerve monitoring of the external branch of the superior laryngeal nerve and the recurrent laryngeal nerve as well as hemostatic devices (harmonic scalpel and LigaSure) and hemostatic agents are frequently used, but are of unclear benefit. This chapter will critically appraise the literature regarding these new technologies and summarize our recommendations.

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References

  1. Dackiw AP, Rotstein LE, Clark OH (2002) Computer-assisted evoked electromyography with stimulating surgical instruments for recurrent/external laryngeal nerve identification and preservation in thyroid and parathyroid operation. Surgery 132(6):1100–1106; discussion 7–8. Epub 2002/12/20

    Article  PubMed  Google Scholar 

  2. Sulica L (2004) The superior laryngeal nerve: function and dysfunction. Otolaryngol Clin North Am 37(1):183–201, Epub 2004/04/06

    Article  PubMed  Google Scholar 

  3. Barczynski M, Randolph GW, Cernea CR, Dralle H, Dionigi G, Alesina PF et al (2013) External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement. Laryngoscope 123(Suppl 4):S1–S14, Epub 2013/07/09

    Article  PubMed  Google Scholar 

  4. Jansson S, Tisell LE, Hagne I, Sanner E, Stenborg R, Svensson P (1988) Partial superior laryngeal nerve (SLN) lesions before and after thyroid surgery. World J Surg 12(4):522–527, Epub 1988/08/01

    Article  PubMed  CAS  Google Scholar 

  5. Cernea CR, Ferraz AR, Nishio S, Dutra A Jr, Hojaij FC, dos Santos LR (1992) Surgical anatomy of the external branch of the superior laryngeal nerve. Head Neck 14(5):380–383, Epub 1992/09/11

    Article  PubMed  CAS  Google Scholar 

  6. Lennquist S, Cahlin C, Smeds S (1987) The superior laryngeal nerve in thyroid surgery. Surgery 102(6):999–1008, Epub 1987/12/01

    PubMed  CAS  Google Scholar 

  7. Cernea CR, Ferraz AR, Furlani J, Monteiro S, Nishio S, Hojaij FC et al (1992) Identification of the external branch of the superior laryngeal nerve during thyroidectomy. Am J Surg 164(6):634–639, Epub 1992/12/01

    Article  PubMed  CAS  Google Scholar 

  8. Lifante JC, McGill J, Murry T, Aviv JE, Inabnet WB 3rd (2009) A prospective, randomized trial of nerve monitoring of the external branch of the superior laryngeal nerve during thyroidectomy under local/regional anesthesia and IV sedation. Surgery 146(6):1167–1173, Epub 2009/12/05

    Article  PubMed  Google Scholar 

  9. Barczynski M, Konturek A, Stopa M, Honowska A, Nowak W (2012) Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy. World J Surg 36(6):1340–1347, Epub 2012/03/10

    Article  PubMed  PubMed Central  Google Scholar 

  10. Rosen CA, Lee AS, Osborne J, Zullo T, Murry T (2004) Development and validation of the voice handicap index-10. Laryngoscope 114(9):1549–1556, Epub 2004/10/12

    Article  PubMed  Google Scholar 

  11. Belafsky PC, Postma GN, Koufman JA (2002) Validity and reliability of the reflux symptom index (RSI). J Voice 16(2):274–277, Epub 2002/08/02

    Article  PubMed  Google Scholar 

  12. Chandrasekhar SS, Randolph GW, Seidman MD, Rosenfeld RM, Angelos P, Barkmeier-Kraemer J et al (2013) Clinical practice guideline: improving voice outcomes after thyroid surgery. Otolaryngol Head Neck Surg 148(6 Suppl):S1–S37, Epub 2013/06/14

    Article  PubMed  Google Scholar 

  13. Eisele DW (1996) Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve. Laryngoscope 106(4):443–449, Epub 1996/04/01

    Article  PubMed  CAS  Google Scholar 

  14. Sturgeon C, Sturgeon T, Angelos P (2009) Neuromonitoring in thyroid surgery: attitudes, usage patterns, and predictors of use among endocrine surgeons. World J Surg 33(3):417–425, Epub 2008/09/02

    Article  PubMed  Google Scholar 

  15. Singer MC, Rosenfeld RM, Sundaram K (2012) Laryngeal nerve monitoring: current utilization among head and neck surgeons. Otolaryngol Head Neck Surg 146(6):895–899, Epub 2012/03/09

    Article  PubMed  Google Scholar 

  16. Dralle H, Sekulla C, Lorenz K, Nguyen Thanh P, Schneider R, Machens A (2012) Loss of the nerve monitoring signal during bilateral thyroid surgery. Br J Surg 99(8):1089–1095, Epub 2012/06/15

    Article  PubMed  CAS  Google Scholar 

  17. Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E et al (2004) Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136(6):1310–1322, Epub 2005/01/20

    Article  PubMed  Google Scholar 

  18. Higgins TS, Gupta R, Ketcham AS, Sataloff RT, Wadsworth JT, Sinacori JT (2011) Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: a meta-analysis. Laryngoscope 121(5):1009–1017, Epub 2011/04/27

    Article  PubMed  Google Scholar 

  19. Dionigi G, Boni L, Rovera F, Bacuzzi A, Dionigi R (2009) Neuromonitoring and video-assisted thyroidectomy: a prospective, randomized case–control evaluation. Surg Endosc 23(5):996–1003, Epub 2008/09/23

    Article  PubMed  Google Scholar 

  20. Barczynski M, Konturek A, Cichon S (2009) Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg 96(3):240–246, Epub 2009/01/30

    Article  PubMed  CAS  Google Scholar 

  21. Randolph GW, Dralle H, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M et al (2011) Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 121(Suppl 1):S1–S16, Epub 2010/12/25

    Article  PubMed  Google Scholar 

  22. Snyder SK, Sigmond BR, Lairmore TC, Govednik-Horny CM, Janicek AK, Jupiter DC (2013) The long-term impact of routine intraoperative nerve monitoring during thyroid and parathyroid surgery. Surgery 154(4):704–711; discussion 11–13. Epub 2013/09/07

    Article  PubMed  Google Scholar 

  23. Sari S, Erbil Y, Sumer A, Agcaoglu O, Bayraktar A, Issever H et al (2010) Evaluation of recurrent laryngeal nerve monitoring in thyroid surgery. Int J Surg 8(6):474–478, Epub 2010/07/06

    Article  PubMed  Google Scholar 

  24. Snyder SK, Lairmore TC, Hendricks JC, Roberts JW (2008) Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidectomy and parathyroidectomy. J Am Coll Surg 206(1):123–130, Epub 2007/12/25

    Article  PubMed  Google Scholar 

  25. Lo CY, Kwok KF, Yuen PW (2000) A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Arch Surg 135(2):204–207, Epub 2000/02/11

    Article  PubMed  CAS  Google Scholar 

  26. Patow CA, Norton JA, Brennan MF (1986) Vocal cord paralysis and reoperative parathyroidectomy. A prospective study. Ann Surg 203(3):282–285, Epub 1986/03/01

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  27. Bergenfelz A, Jansson S, Kristoffersson A, Martensson H, Reihner E, Wallin G et al (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 393(5):667–673, Epub 2008/07/18

    Article  PubMed  CAS  Google Scholar 

  28. Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A (2008) Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 32(7):1358–1366, Epub 2008/02/29

    Article  PubMed  CAS  Google Scholar 

  29. Goretzki PE, Schwarz K, Brinkmann J, Wirowski D, Lammers BJ (2010) The impact of intraoperative neuromonitoring (IONM) on surgical strategy in bilateral thyroid diseases: is it worth the effort? World J Surg 34(6):1274–1284, Epub 2010/02/10

    Article  PubMed  Google Scholar 

  30. Ulmer C, Friedrich C, Kohler A, Rieber F, Basar T, Deuschle M et al (2011) Impact of continuous intraoperative neuromonitoring on autonomic nervous system during thyroid surgery. Head Neck 33(7):976–984, Epub 2011/06/16

    Article  PubMed  Google Scholar 

  31. Lamade W, Ulmer C, Seimer A, Molnar V, Meyding-Lamade U, Thon KP et al (2007) A new system for continuous recurrent laryngeal nerve monitoring. Minim Invasive Ther Allied Technol 16(3):149–154, Epub 2007/06/19

    Article  PubMed  Google Scholar 

  32. Schneider R, Randolph GW, Sekulla C, Phelan E, Thanh PN, Bucher M et al (2013) Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Head Neck 35(11):1591–1598, Epub 2012/11/22

    Article  PubMed  Google Scholar 

  33. Phelan E, Schneider R, Lorenz K, Dralle H, Kamani D, Potenza A et al (2014) Continuous vagal IONM prevents recurrent laryngeal nerve paralysis by revealing initial EMG changes of impending neuropraxic injury: a prospective, multicenter study. Laryngoscope 124(6):1498–1505, Epub 2013/12/07

    Article  PubMed  Google Scholar 

  34. Musholt TJ, Clerici T, Dralle H, Frilling A, Goretzki PE, Hermann MM et al (2011) German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease. Langenbecks Arch Surg 396(5):639–649, Epub 2011/03/23

    Article  PubMed  Google Scholar 

  35. Lombardi CP, Raffaelli M, Cicchetti A, Marchetti M, De Crea C, Di Bidino R et al (2008) The use of “harmonic scalpel” versus “knot tying” for conventional “open” thyroidectomy: results of a prospective randomized study. Langenbecks Arch Surg 393(5):627–631, Epub 2008/07/16

    Article  PubMed  Google Scholar 

  36. Miccoli P, Berti P, Dionigi G, D’Agostino J, Orlandini C, Donatini G (2006) Randomized controlled trial of harmonic scalpel use during thyroidectomy. Arch Otolaryngol Head Neck Surg 132(10):1069–1073, Epub 2006/10/18

    Article  PubMed  Google Scholar 

  37. Defechereux T, Rinken F, Maweja S, Hamoir E, Meurisse M (2003) Evaluation of the ultrasonic dissector in thyroid surgery. A prospective randomised study. Acta Chir Belg 103(3):274–277, Epub 2003/08/14

    PubMed  Google Scholar 

  38. Melck AL, Wiseman SM (2010) Harmonic scalpel compared to conventional hemostasis in thyroid surgery: a meta-analysis of randomized clinical trials. Int J Surg Oncol 2010:396079, Epub 2010/01/01

    PubMed  PubMed Central  Google Scholar 

  39. Saint Marc O, Cogliandolo A, Piquard A, Fama F, Pidoto RR (2007) LigaSure vs clamp-and-tie technique to achieve hemostasis in total thyroidectomy for benign multinodular goiter: a prospective randomized study. Arch Surg 142(2):150–156; discussion 7. Epub 2007/02/21

    Article  PubMed  Google Scholar 

  40. Yao HS, Wang Q, Wang WJ, Ruan CP (2009) Prospective clinical trials of thyroidectomy with LigaSure vs conventional vessel ligation: a systematic review and meta-analysis. Arch Surg 144(12):1167–1174, Epub 2009/12/23

    Article  PubMed  Google Scholar 

  41. Contin P, Goossen K, Grummich K, Jensen K, Schmitz-Winnenthal H, Buchler MW et al (2013) ENERgized vessel sealing systems versus CONventional hemostasis techniques in thyroid surgery – the ENERCON systematic review and network meta-analysis. Langenbecks Arch Surg 398(8):1039–1056, Epub 2013/11/19

    Article  PubMed  Google Scholar 

  42. Ortega J, Sala C, Flor B, Lledo S (2004) Efficacy and cost-effectiveness of the UltraCision harmonic scalpel in thyroid surgery: an analysis of 200 cases in a randomized trial. J Laparoendosc Adv Surg Tech A 14(1):9–12, Epub 2004/03/24

    Article  PubMed  Google Scholar 

  43. O’Neill CJ, Chang LY, Suliburk JW, Sidhu SB, Delbridge LW, Sywak MS (2011) Sutureless thyroidectomy: surgical technique. ANZ J Surg 81(7–8):515–518

    Article  PubMed  Google Scholar 

  44. Amit M, Binenbaum Y, Cohen JT, Gil Z (2013) Effectiveness of an oxidized cellulose patch hemostatic agent in thyroid surgery: a prospective, randomized, controlled study. J Am Coll Surg 217(2):221–225, Epub 2013/07/23

    Article  PubMed  Google Scholar 

  45. Testini M, Marzaioli R, Lissidini G, Lippolis A, Logoluso F, Gurrado A et al (2009) The effectiveness of FloSeal matrix hemostatic agent in thyroid surgery: a prospective, randomized, control study. Langenbecks Arch Surg 394(5):837–842, Epub 2009/05/08

    Article  PubMed  Google Scholar 

  46. Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R (1998) The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 228(3):320–330, Epub 1998/09/22

    Article  PubMed  CAS  PubMed Central  Google Scholar 

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Correspondence to Julie Ann Sosa .

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Scheri, R.P., Sosa, J.A. (2016). Critical Appraisal. In: Lombardi, C., Bellantone, R. (eds) Minimally Invasive Therapies for Endocrine Neck Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-20065-1_21

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  • DOI: https://doi.org/10.1007/978-3-319-20065-1_21

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-20064-4

  • Online ISBN: 978-3-319-20065-1

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