Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement

Authors

  • Gregory W. Randolph MD,

    Corresponding author
    1. Department of Otology and Laryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School,Boston, Massachusetts, U.S.A.
    2. Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School,, Boston, Massachusetts, U.S.A.
    • Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114
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  • Henning Dralle MD,

    1. Department of Surgery and Department of General, Visceral, and Vascular Surgery, University of Halle, Halle, Germany
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  • with the International Intraoperative Monitoring Study Group,

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    • Drs. Randolph and Dralle are members of the International Intraoperative Monitoring Study Group

  • Hisham Abdullah MD,

  • Marcin Barczynski MD,

  • Rocco Bellantone MD,

  • Michael Brauckhoff MD,

  • Bruno Carnaille MD,

  • Sergii Cherenko MD,

  • Fen-Yu Chiang MD,

  • Gianlorenzo Dionigi MD, FACS,

  • Camille Finck MD,

  • Dana Hartl MD,

  • Dipti Kamani MD,

  • Kerstin Lorenz MD,

  • Paolo Miccolli MD,

  • Radu Mihai MD, PhD, FRCS,

  • Akira Miyauchi MD, PhD,

  • Lisa Orloff MD, FACS,

  • Nancy Perrier MD, FACS,

  • Manuel Duran Poveda MD,

  • Anatoly Romanchishen MD,

  • Jonathan Serpell MD, FRACS, FACS,

  • Antonio Sitges-Serra MD,

  • Tod Sloan MD, MBA, PhD,

  • Sam Van Slycke MD,

  • Samuel Snyder MD, FACS,

  • Hiroshi Takami MD,

  • Erivelto Volpi MD,

  • Gayle Woodson MD


  • The authors have no funding, financial relationships, or conflicts of interest to disclose

Abstract

Intraoperative neural monitoring (IONM) during thyroid and parathyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual nerve identification. Despite the increasing use of IONM, review of the literature and clinical experience confirms there is little uniformity in application of and results from nerve monitoring across different centers. We provide a review of the literature and cumulative experience of the multidisciplinary International Neural Monitoring Study Group with IONM spanning nearly 15 years. The study group focused its initial work on formulation of standards in IONM as it relates to important areas: 1) standards of equipment setup/endotracheal tube placement and 2) standards of loss of signal evaluation/intraoperative problem-solving algorithm. The use of standardized methods and reporting will provide greater uniformity in application of IONM. In addition, this report clarifies the limitations of IONM and helps identify areas where additional research is necessary. This guideline is, at its forefront, quality driven; it is intended to improve the quality of neural monitoring, to translate the best available evidence into clinical practice to promote best practices. We hope this work will minimize inappropriate variations in monitoring rather than to dictate practice options. Laryngoscope, 121:S1–S16, 2011

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