Evidence-based medicine measures for neural monitoring in thyroid surgery
Editorial

Evidence-based medicine measures for neural monitoring in thyroid surgery

Guido Nicola Zanghì1, Hui Sun2, Gianlorenzo Dionigi3

1Department of Surgery, Policlinico Vittorio Emanuele University Hospital, General Surgery and Oncology Unit, University of Catania, Catania, Italy; 2Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, China-Japan Union Hospital of Jilin University, Changchun 130033, China; 3Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital G. Martino, University of Messina, Messina, Italy

Correspondence to: Prof. Gianlorenzo Dionigi. Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital G. Martino, University of Messina, Via C. Valeria 1, 98125 Messina, Italy. Email: gdionigi@unime.it.

Received: 07 February 2018; Accepted: 18 March 2018; Published: 20 April 2018.

doi: 10.21037/aot.2018.03.03

Intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery is not based on class I evidence. IONM in thyroid surgery is currently limited to class II and III studies (1-7).

Actually, none IONM technique applied in any field of general surgery [as in neurosurgery, orthopedics, spinal surgery, ear, nose, throat (ENT), facial nerve, vascular] acquire class I evidence (1).

Furthermore, IONM should be equalized at same level of significance of any other technology applied to most our clinical practice within thyroid and parathyroid surgery as for the use of energy based devices, endoscopy, robotic, intact parathyroid hormone (iPTH) measurement, thermal ablation, screening (1-7).

Wherefore, the level of evidence is not defective than that found mostly for any technology proposed and applied in thyroid surgery (8,9).

For IONM to be valuable (I) must furnish instantly information of impending recurrent laryngeal nerve (RLN) damage early enough to permit the thyroid surgeon to take conveniently measures to inverse or underrate the harm (II) simply to adapt, perform and read, (III) accessible resource (IV) cost-effective (1-7).

Practically, evidence-based measures for IONM in thyroid surgery protocol studies hardly can incorporate surgeon clinical emprise (i.e., optimization of nerve dissection) and intraoperative decision making (i.e., avoidance of bilateral RLN injury), patient expense for RLN injury, and pathophysiologic rationale (i.e., research).

Unlikely class I protocol studies will ever occur again after the one by Barczyński et al. (8,9). The likelihood of preventing RLN injury using IONM and the incidence of permanent RLN complications is very low (8,9). One randomized study evaluated prospectively IONM in thyroid surgery. The prevalence of transient RLN paresis was lower in patients who had RLN monitoring by 2.9 percent in high-risk patients (P=0.011) and 0.9 percent in low-risk patients (P=0.249) (8,9).

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was a standard submission to the journal. The article has undergone external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/aot.2018.03.03). Gianlorenzo Dionigi serves as an unpaid editorial board member of Annals of Thyroid from Mar. 2017 to Feb. 2019. Hui Sun serves as an unpaid editorial board member of Annals of Thyroid from May 2017 to Apr. 2019. The other author has no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the manuscript and ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

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doi: 10.21037/aot.2018.03.03
Cite this article as: Zanghì GN, Sun H, Dionigi G. Evidence-based medicine measures for neural monitoring in thyroid surgery. Ann Thyroid 2018;3:10.

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