Intraoperative Neuromonitoring for Surgical Training in Thyroid Surgery: Its Routine Use Allows a Safe Operation Instead of Lack of Experienced Mentoring
Intraoperative Neuromonitoring for Surgical Training in Thyroid Surgery: Its Routine Use Allows a Safe Operation Instead of Lack of Experienced Mentoring
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DOI：
10.1007/s00268-013-2372-3
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发表时间：
2014-03-01
影响因子：
2.6
通讯作者：
Walz, M. K.
中科院分区：
文献类型：
--
作者：
Alesina, P. F.;Hinrichs, J.;Walz, M. K.
背景本研究的目的是评估术中神经监测（NM）对手术训练的影响。甲状腺切除术的结果进行了比较，没有经验的外科医生的顾问外科医生的监督下，没有术中神经监测（ioNM）进行的操作，没有经验的援助，但根据neuromonitoring control.Materials和方法该研究包括甲状腺手术在我们的部门之间进行2005年和2012年。其中，住院医生或研究员进行了1,116例手术。765例手术无神经监测（NV组），351例有神经监测。NV组行单侧手术375例，双侧手术390例。NM组行单侧手术149例，双侧手术202例。研究的主要终点是术后喉返神经麻痹的发生率。第二个终点是ioNM对手术时间和手术策略的影响。结果NV组喉返神经（RLN）麻痹的发生率为2.6%，NM组为2.7%[p = ns]。NV组中观察到1例双侧RLN麻痹。NM组的手术时间较长（分别为50 vs. 56 min和76 vs. 81 min; p < 0.05）。结论甲状腺手术中常规使用间歇性术中神经监测并不能降低喉返神经麻痹的发生率。尽管如此，它允许没有经验的外科医生进行安全的手术，并发症发生率与有经验的外科医生监督下获得的并发症发生率相当。此外，ioNM可以避免不幸发生的双侧喉返神经麻痹。
Background The aim of the present study was to evaluate the influence of intraoperative neuromonitoring (NM) on surgical training. The results of thyroidectomy performed by inexperienced surgeons under the supervision of a consultant surgeon without intraoperative neuromonitoring (ioNM) were compared to those of the operations performed without experienced assistance but under neuromonitoring control.Materials and methods The study included the thyroid operations performed in our Department between 2005 and 2012. Among them, residents or fellows performed 1,116 procedures. Seven hundred sixty-five operations were conducted without neuromonitoring (NV group) and 351 with NM group. In the NV group 375 unilateral and 390 bilateral operations were performed. In the NM group 149 unilateral and 202 bilateral operations were performed. Primary end point of the study was the incidence of postoperative recurrent laryngeal nerve palsy. A secondary end point was the impact of ioNM on operating time and operative strategy.Results The incidence of recurrent laryngeal nerve (RLN) palsy was 2.6 % in the NV group and 2.7 % in the NM group [p = ns]. One case of bilateral RLN palsy was observed in the NV group. The operative time was longer in the NM group for both lobectomy and total thyroidectomy (50 vs. 56 min and 76 vs. 81 min, respectively; p < 0.05).Conclusions The routine use of intermittent intraoperative neuromonitoring during thyroid operations does not reduce the incidence of RLN palsy. Nevertheless, it allows inexperienced surgeons to perform a safe operation with a complication rate comparable to that obtained under supervision of an experienced surgeon. Moreover, ioNM could avoid the unfortunate occurrence of a bilateral RLN palsy.