Öz
Aim: Intraoperative nerve monitoring (IONM) during thyroid surgery has been widely accepted as an additive improvement to the gold standard of visually identifying the RLN. This study aims to evaluate the role of IONM application in thyroid surgery education during general surgery residency.
Materials and Methods: Patients who underwent total thyroidectomy between January 2012 and December 2019 were included in the study. The patients were divided into 2 groups according to the use of IONM (Group 1: With IONM, Group 2: Without IONM). These groups were also divided into subgroups as assistants and experts among themselves.
Results: This study involved 256 patients. There were 116 patients in group 1, and 140 patients in group 2. Histologic analysis results revealed that IONM was used more frequently in patients with a
malignancy (p=0.015). The median operative time was significantly longer when IONM was used, with an operative time of 130 minutes for group 1 and 120 minutes for group 2 (p=0.015). When Group 1B and Group 2B were compared among themselves, the median operation time in Group 1B was 130 minutes, and the median operation time in Group 2B was 125 minutes (p=0.026). In the comparison between Groups 1B and 2B, it was detected that the rate of use of IONM was higher in malignancies
(p=0.025).
Conclusion: According to our results, the use of IONM did not reduce the incidence of RLN paralysis in thyroidectomy performed by specialists and residents.
Anahtar Kelimeler
Thyroidectomy intraoperative nerve monitoring thyroid surgery training
Kaynakça
- Sosa JA, Wang TS, Yeo HL, et al. The maturation of a specialty: workforce projections for endocrine surgery. Surgery. 2007; 142: 876– 83.
- Ali U Emre, Güldeniz Karadeniz Cakmak, Oge Tascilar, Bülent H Ucan, Oktay Irkorucu, Kemal Karakaya et al.Complications of total thyroidectomy performed by surgical residents versus specialist surgeons. Surg Today. 2008; 38 (10): 879-85. doi:10.1007/s00595-008-3760-4.
- Adam MA, Thomas S, Youngwirth L, Hyslop T, Reed SD, Scheri RP, et al. Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes? Ann Surg. 2017; 265 (2): 402-7.
- http://www.acgme.org/Portals/0/440_GS_Defined Category Minimum Numbers.pdf
- Jatzko GR, Lisborg PH, Muller MG, Wette VM. Recurrent nerve palsy after thyroid operations: principal nerve identification and a literatüre review. Surgery 1994; 115: 139-44.
- Candaş Erçetin, Alper Şahbaz, Sami Acar, Fırat Tutal, Nihat Aksakal, Serkan Sarı, Yeşim Erbil. Is intraoperative nerve monitoring useful for surgical training in thyroid surgery? Turk J SurG. 2018 Nov 20; 35 (4): 259-64. doi:10.5578/turkjsurg.4281.
- Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP 2014 Systematic review and meta-analysis of predictors of post-thyroidectomyhypocalcaemia. Br J Surg 101: 307-20.
- Jeannon JP, Orabi AA, Bruch GA, Abdalsalam HA, Simo R. Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review. Int J Clin Pract 2009; 63: 624–9.
- Peter Angelos. Recurrent laryngeal nevre monitoring. state of the art, ethical and legal issues. Surg Clin North Am 2009 Oct; 89 (5): 1157-69.
- Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, et al. Risk factors of paralysis and functional outcome after recurrentlaryngeal nerve monitoring in thyroid surgery. Surgery 2004; 136: 1310-22.
- Hermann M, Hellebart C, Freissmuth M. Neuromonitoring in thyroid surgery: prospective evaluation of intraoperative electrophysiological responses for the prediction of recurrent laryngeal nerve injury. Ann Surg 2004; 240: 9-17.
- Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A; German IONM Study Group. Intraoperative monitoring of the recurrent laryngealnerve in thyroid surgery. World J Surg 2008; 32: 1358-66.
- Chan WF, Lang BH, Lo CY. The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk. Surgery 2006; 140: 866-72.
- Loch-Wilkinson TJ, Stalberg PL, Sidhu SB, Sywak MS, Wilkinson JF, Delbridge LW. Nerve stimulation in thyroid surgery: is it really useful? ANZ J Surg 2007; 77: 377-80.
- Alesina PF, Hinrichs J, Meier B, Cho EY, Bolli M, Walz MK. Intraoperative neuromonitoring for surgical training in thyroid surgery: its routine use allows a safe operation instead of lack of experienced mentoring. World J Surg 2014; 38: 592-8.
Öz
Amaç: Tiroid cerrahisi sırasında intraoperatif sinir monitörizasyonu (İONM), rekürren laringeal siniri (RLS) görsel olarak tanımlamanın altın standardına ilave bir gelişme olarak geniş çapta kabul
görmüştür. Bu çalışma, genel cerrahi ihtisası sırasında tiroid cerrahisi eğitiminde İONM uygulamasının rolünü değerlendirmeyi amaçlamaktadır.
Gereç ve Yöntem: Ocak 2012-Aralık 2019 tarihleri arasında total tiroidektomi yapılan hastalar çalışmaya dahil edildi. Hastalar İONM kullanımına göre 2 gruba ayrıldı (Grup 1: İONM'li, Grup 2: İONM'siz). Bu gruplar da kendi aralarında asistan ve uzman olarak alt gruplara ayrılmıştır.
Bulgular: Bu çalışmaya 256 hasta dahil edildi. Grup 1'de 116, grup 2'de 140 hasta vardı. Histolojik analiz sonuçları İONM'nin malignitesi olan hastalarda daha sık kullanıldığını gösterdi (p=0.015). Grup 1 için 130 dakika ve grup 2 için 120 dakika operasyon süresi ile IONM kullanıldığında medyan operasyon süresi anlamlı olarak daha uzundu (p=0.015). Grup 1B ve Grup 2B kendi aralarında
karşılaştırıldığında Grup 1B'de ortanca ameliyat süresi 130 dakika, Grup 2B'de ortanca ameliyat süresi 125 dakika idi (p=0.026). Grup 1B ve 2B karşılaştırmasında malignitelerde İONM kullanım oranının
daha yüksek olduğu saptandı (p=0.025).
Sonuç: Sonuçlarımıza göre uzman ve asistanlar tarafından yapılan tiroidektomilerde İONM kullanımı
RLS paralizi insidansını azaltmamıştır.
Anahtar Kelimeler
Tiroidektomi intraoperatif sinir monitörizasyonu tiroid cerrahisi eğitimi
Kaynakça
- Sosa JA, Wang TS, Yeo HL, et al. The maturation of a specialty: workforce projections for endocrine surgery. Surgery. 2007; 142: 876– 83.
- Ali U Emre, Güldeniz Karadeniz Cakmak, Oge Tascilar, Bülent H Ucan, Oktay Irkorucu, Kemal Karakaya et al.Complications of total thyroidectomy performed by surgical residents versus specialist surgeons. Surg Today. 2008; 38 (10): 879-85. doi:10.1007/s00595-008-3760-4.
- Adam MA, Thomas S, Youngwirth L, Hyslop T, Reed SD, Scheri RP, et al. Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes? Ann Surg. 2017; 265 (2): 402-7.
- http://www.acgme.org/Portals/0/440_GS_Defined Category Minimum Numbers.pdf
- Jatzko GR, Lisborg PH, Muller MG, Wette VM. Recurrent nerve palsy after thyroid operations: principal nerve identification and a literatüre review. Surgery 1994; 115: 139-44.
- Candaş Erçetin, Alper Şahbaz, Sami Acar, Fırat Tutal, Nihat Aksakal, Serkan Sarı, Yeşim Erbil. Is intraoperative nerve monitoring useful for surgical training in thyroid surgery? Turk J SurG. 2018 Nov 20; 35 (4): 259-64. doi:10.5578/turkjsurg.4281.
- Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP 2014 Systematic review and meta-analysis of predictors of post-thyroidectomyhypocalcaemia. Br J Surg 101: 307-20.
- Jeannon JP, Orabi AA, Bruch GA, Abdalsalam HA, Simo R. Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review. Int J Clin Pract 2009; 63: 624–9.
- Peter Angelos. Recurrent laryngeal nevre monitoring. state of the art, ethical and legal issues. Surg Clin North Am 2009 Oct; 89 (5): 1157-69.
- Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, et al. Risk factors of paralysis and functional outcome after recurrentlaryngeal nerve monitoring in thyroid surgery. Surgery 2004; 136: 1310-22.
- Hermann M, Hellebart C, Freissmuth M. Neuromonitoring in thyroid surgery: prospective evaluation of intraoperative electrophysiological responses for the prediction of recurrent laryngeal nerve injury. Ann Surg 2004; 240: 9-17.
- Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A; German IONM Study Group. Intraoperative monitoring of the recurrent laryngealnerve in thyroid surgery. World J Surg 2008; 32: 1358-66.
- Chan WF, Lang BH, Lo CY. The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk. Surgery 2006; 140: 866-72.
- Loch-Wilkinson TJ, Stalberg PL, Sidhu SB, Sywak MS, Wilkinson JF, Delbridge LW. Nerve stimulation in thyroid surgery: is it really useful? ANZ J Surg 2007; 77: 377-80.
- Alesina PF, Hinrichs J, Meier B, Cho EY, Bolli M, Walz MK. Intraoperative neuromonitoring for surgical training in thyroid surgery: its routine use allows a safe operation instead of lack of experienced mentoring. World J Surg 2014; 38: 592-8.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Mart 2023 |
| Gönderilme Tarihi | 18 Mayıs 2022 |
| Yayımlandığı Sayı | Yıl 2023 |