International consensus (ICON) on comprehensive management of the laryngeal nerves risks during thyroid surgery - 21/02/18

Doi : 10.1016/j.anorl.2017.11.010

S. Périé ^a,^⁎ , J. Santini ^b, H.Y. Kim ^c, H. Dralle ^d, G.W. Randolph ^e
^a Service Oto-rhino-laryngologie et Chirurgie Cervico-faciale, Hôpital Tenon, Faculté Médecine Sorbonne Université, AP–HP, 4, rue de la Chine, 75020 Paris, France
^b Chirurgie de la face et du cou, IUFC-CHU de Nice, 31, avenue Valombrose, 06100 Nice, France
^c Korea university hospital, Korea university college of medicine, department of surgery, division of breast and endocrine surgery, Seoul. Korea
^d University hospital Essen, section of endocrine surgery, department of general, visceral and transplantation surgery, FEBS Head, Essen, Germany
^e Harvard Medical School, Massachusetts general hospital, Massachusetts Eye and Ear Infirmary, thyroid/parathyroid endocrine surgical divisions, USA

^⁎Corresponding author.

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Abstract

The laryngeal monitoring of the inferior and superior laryngeal nerves, and the vagus nerve, has advanced for last years, in practice of thyroid and parathyroid surgery. Different methods are used, using direct or indirect laryngeal stimulation and also intermittent or continuous nerve registration. At present time, various recommendations of it in the world use are reported, and availability of the tool used remains a limit in some countries. The aim of this Icon during Ifos 2017 was to share knowledge about laryngeal intraoperative nerve monitoring (LIONM) procedures and to evaluate current practices used to improve the quality of thyroid and parathyroid surgery. Benefits of LIONM were discussed with three experts (Pr G. Randolph from Boston, Pr Henning Dralle from Halle in Germany, Pr Hoon Yub KIM from Seoul). All of them have been actively involved in the development and use of laryngeal nerve monitoring during thyroid and parathyroid surgery.

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Keywords : Laryngeal intraoperative nerve monitoring (LIONM), Recurrent or inferior laryngeal nerve, Vagus nerve, Laryngeal paralysis, Thyroid surgery, Parathyroid surgery

Plan

Introduction

Selected questions

Which system of LIONM do you use during thyroid/parathyroid surgery (electrodes on endotracheal tube, translaryngeal electrodes)?

Which nerves are systematically recorded by laryngeal IONM during thyroid/parathyroid surgery? Is there specific method for LIONM during robotic thyroid surgery?

Is continuous LIONM indicated in selected cases?

How do you confirm loss of signal during LIONM and consequences on surgery?

In cases of laryngeal IONM not available, do you modify the dissection of the RLN?

Usefulness of LIONM for prognosis of laryngeal nerve paralysis?

Conclusion, experts’ recommendations

Disclosure of interest

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Vol 135 - N° 1S

P. S7-S10 - février 2018 Retour au numéro

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International consensus (ICON) on comprehensive management of the laryngeal nerves risks during thyroid surgery - 21/02/18

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