Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: A retrospective analysis and prospective follow-up.

OBJECTIVES: To compare continuous (C-IONM) vs intermittent intraoperative neuromonitoring (I-IONM) in complex benign thyroid surgery, and to follow up patients with loss of signal (LOS) or unilateral vocal fold paralysis (UVFP). DESIGN: Retrospective clinical study, prospective case series. SETTING: University hospital and academic teaching hospital of Charité-University Medicine Berlin, Germany. PARTICIPANTS: C-IONM- and I-IONM-assisted thyroid surgery was conducted in 357 patients diagnosed with recurrent goitre, Graves' disease, complex hyperparathyroidism, cervical preoperation (anterior access) and LOS in primary operation (2-stage thyroidectomy). MAIN OUTCOME MEASURES: To evaluate the incidence of early postoperative and permanent UVFP, and to report the results of phonosurgical therapy in patients suffering from persisting dysphonia. RESULTS: In 346 patients enrolled (81.8% female, 18.2% male) with 613 nerves at risk (NAR) being monitored (409 I-IONM vs 204 C-IONM), early postoperative UVFP was observed in 10.5% of I-IONM vs 4.9% of C-IONM group (P < .05), permanent paralysis in 1.5% of I-IONM vs 1.0% of C-IONM group (P = .619). In total, 72 patients (21%) experienced pathological events (19 LOS < 100 µV, 53 transient or permanent UVFP). Three patients with permanent UVFP and persisting dysphonia received phonosurgery with stable improvements of all acoustic-aerodynamic parameters. CONCLUSION: Compared to I-IONM, C-IONM-application in complex benign thyroid surgery shows a significant reduction of transient UVFP and a non-significant trend in preventing permanent UVFP. In persistent UVFP with dysphonia, endolaryngeal phonomicrosurgery and transcervical laryngeal framework surgery are long-term effective treatment approaches to improve vocal function.

Early experience with a novel gelatine-based sponge for local haemostasis in thyroid surgery.

AIM: The aim of the present investigation was to assess the feasibility, efficacy and safety of a novel gelatine-based sponge as a haemostat in thyroid surgery. PATIENTS AND METHODS: A questionnaire was completed by surgeons after having used the sponge in thyroid surgery. The product in general, its effectiveness as a haemostat, its absorption capacity and handling issues were rated. Moreover unexpected complications or side-effects were documented. RESULTS: Whenever thyroid resections were performed by the members of our study group (11 consultant surgeons in 8 hospitals specialized in thyroid surgery) the new haemostat was used during the period of surveillance. It was mainly rated as "excellent" or "good" by the study group members who used the product in 87 thyroid resections. Its effectiveness as a haemostat, its absorption capacity and handling issues were also rated as excellent. No poor results were reported. Complications occurred in only 2% of cases and were related to inappropriate application. CONCLUSION: The evaluated data demonstrated that the sponge has an excellent safety and haemostatic efficacy in surgical application. The product is user-friendly and demonstrated its effectiveness as a haemostat and its excellent absorption capacity.