본문 바로가기
KERD
논문KCI 등재

Two-Stage Thyroidectomy Driven by Intraoperative Neuromonitoring: Informed Consent Process and Its Effect on Patient Willingness and Consent Rates

0

조회

0

다운로드

1

인용

0

참고문헌

키워드

초록

Purpose: Intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) is a useful technique that can be applied to assess the nerve functionality at the end of the first side lobectomy in a planned total resection to prevent the bilateral injury of the RLN. Here we describe the process of informed consent of patients, who were subjected to a 2-stage thyroidectomy, and its effect on the patients' willingness to be operated on as well as their consent rates. Methods: A retrospective observational study of patients, undergoing thyroidectomy with standardized IONM, was conducted from January 2019 to December 2019. All patients were preoperatively informed about the possibility of undergoing a 2-stage thyroidectomy. The outcome of this information was evaluated through a specific questionnaire that the patients were asked to fill in. Results: Eighty patients were initially included in the analysis. The treatment was discontinued in 8 patients, who were originally eligible to total thyroidectomy, due to the detection of a loss of signal in the electromyography. The analysis of the results of the questionnaires highlighted a high compliance of the patients with the expectation of a possible new intervention. Conclusion: Two-stage thyroidectomy proved to be a reliable surgical approach and appeared to be largely accepted by the patients.

Abstract

Purpose: Intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) is a useful technique that can be applied to assess the nerve functionality at the end of the first side lobectomy in a planned total resection to prevent the bilateral injury of the RLN. Here we describe the process of informed consent of patients, who were subjected to a 2-stage thyroidectomy, and its effect on the patients' willingness to be operated on as well as their consent rates. Methods: A retrospective observational study of patients, undergoing thyroidectomy with standardized IONM, was conducted from January 2019 to December 2019. All patients were preoperatively informed about the possibility of undergoing a 2-stage thyroidectomy. The outcome of this information was evaluated through a specific questionnaire that the patients were asked to fill in. Results: Eighty patients were initially included in the analysis. The treatment was discontinued in 8 patients, who were originally eligible to total thyroidectomy, due to the detection of a loss of signal in the electromyography. The analysis of the results of the questionnaires highlighted a high compliance of the patients with the expectation of a possible new intervention. Conclusion: Two-stage thyroidectomy proved to be a reliable surgical approach and appeared to be largely accepted by the patients.

참고문헌 (27)

  1. Lahey FH, "Injuries to the recurrent laryngeal nerve in thyroid operations : their management and avoidance", Ann Surg, 108, pp.545~562 (1938)
  2. Riddell V, "Thyroidectomy: prevention of bilateral recurrent nerve palsy. Results of identification of the nerve over 23 consecutive years (1946–69) with a description of an additional safety measure", Br J Surg, 57, pp.1~11 (1970)
  3. Dralle H, "Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery", World J Surg, 32, pp.1358~1366 (2008)
  4. Randolph GW, "Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement", Laryngoscope, 121(Suppl 1), pp.S1~S16 (2011)
  5. Hermann M, "Neuromonitoring in thyroid surgery : prospective evaluation of intraoperative electrophysiological responses for the prediction of recurrent laryngeal nerve injury", Ann Surg, 240, pp.9~17 (2004)
  6. Barczyński M, "Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy", Br J Surg, 96, pp.240~246 (2009)
  7. Chiang FY, "The mechanism of recurrent laryngeal nerve injury during thyroid surgery--the application of intraoperative neuromonitoring", Surgery, 143, pp.743~749 (2008)
  8. Chan WF, "The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy : a comparative study on 1000 nerves at risk", Surgery, 140, pp.866~872 (2006)
  9. Shindo M, "Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy", Arch Otolaryngol Head Neck Surg, 133, pp.481~485 (2007)
  10. Sturgeon C, "Neuromonitoring in thyroid surgery : attitudes, usage patterns, and predictors of use among endocrine surgeons", World J Surg, 33, pp.417~425 (2009)
  11. Vasileiadis I, "Association of intraoperative neuromonitoring with reduced recurrent laryngeal nerve injury in patients undergoing total thyroidectomy", JAMA Otolaryngol Head Neck Surg, 142, pp.994~1001 (2016)
  12. Higgins TS, "Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy : a meta-analysis", Laryngoscope, 121, pp.1009~1017 (2011)
  13. Dralle H, "Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery", Surgery, 136, pp.1310~1322 (2004)
  14. Bergenfelz A, "Complications to thyroid surgery : results as reported in a database from a multicenter audit comprising 3, 660 patients", Langenbecks Arch Surg, 393, pp.667~673 (2008)
  15. Khamsy L, "Loss of neuromonitoring signal during bilateral thyroidectomy : no systematic change in operative strategy according to a survey of the French Association of Endocrine Surgeons(AFCE)", BMC Surg, 15, pp.95~ (2015)
  16. Dralle H, "Loss of the nerve monitoring signal during bilateral thyroid surgery", Br J Surg, 99, pp.1089~1095 (2012)
  17. Barczyński M, "Intraoperative nerve monitoring can reduce prevalence of recurrent laryngeal nerve injury in thyroid reoperations : results of a retrospective cohort study", World J Surg, 38, pp.599~606 (2014)
  18. Jeannon JP, "Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy : a systematic review", Int J Clin Pract, 63, pp.624~629 (2009)
  19. Dionigi G, "Postoperative laryngoscopy in thyroid surgery : proper timing to detect recurrent laryngeal nerve injury", Langenbecks Arch Surg, 395, pp.327~331 (2010)
  20. Goretzki PE, "The impact of intraoperative neuromonitoring(IONM)on surgical strategy in bilateral thyroid diseases : is it worth the effort", World J Surg, 34, pp.1274~1284 (2010)
  21. Sadowski SM, "Systematic use of recurrent laryngeal nerve neuromonitoring changes the operative strategy in planned bilateral thyroidectomy", Thyroid, 23, pp.329~333 (2013)
  22. Mangano A, "Evidence-based analysis on the clinical impact of intraoperative neuromonitoring in thyroid surgery : state of the art and future perspectives", Surg Technol Int, 25, pp.91~96 (2014)
  23. Schneider R, "Evolution of nerve injury with unexpected EMG signal recovery in thyroid surgery using continuous intraoperative neuromonitoring", World J Surg, 37, pp.364~368 (2013)
  24. Dionigi G, "Staged thyroidectomy : time to consider intraoperative neuromonitoring as standard of care", Thyroid, 23, pp.906~908 (2013)
  25. Cooper DS, "Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer", Thyroid, 19, pp.1167~1214 (2009)
  26. Christoforides C, "Two-stage thyroidectomy in the era of intraoperative neuromonitoring", Gland Surg, 6, pp.453~463 (2017)
  27. Wu CW, "International neuromonitoring study group guidelines 2018: part II: optimal recurrent laryngeal nerve management for invasive thyroid cancer-incorporation of surgical, laryngeal, and neural electrophysiologic data", Laryngoscope, 128(Suppl 3), pp.S18~S27 (2018)

관련 논문AI추천

Future Directions of Neural Monitoring in Thyroid Surgery김훈엽, 채영준, Che-Wei Wu, Gianlorenzo Dionigi, Xiaoli Liu대한내분비외과학회 · Journal of Endocrine Surgery2017 · 제17권 제3호Loss of the Neuromonitoring Signal on the First Side in Planned Total Thyroidectomy김훈엽, 채영준, Gianlorenzo Dionigi, Giuseppe Navarra, Henning Dralle, Hui Sun, Korean Intraoperative Neural Monitoring Society (KINMoS), Ralph Tufano대한내분비외과학회 · Journal of Endocrine Surgery2017 · 제17권 제3호The Consistency of Intraoperative Neural Monitoring in Thyroid Surgery김훈엽, 채영준, Bruno Galletti, Francesco Freni, Francesco Galletti, Gianlorenzo Dionigi, Özer Makay대한내분비외과학회 · Journal of Endocrine Surgery2018 · 제18권 제2호Medico-Legal Issues of Intraoperative Neuromonitoring in Thyroid Surgery김훈엽, 정웅윤, 채영준, Che-Wei Wu, Gianlorenzo Dionigi, Henning Dralle, Hui Sun, Matteo Lavazza, Ralph Tufano, Xiaoli Liu대한내분비외과학회 · Journal of Endocrine Surgery2017 · 제17권 제2호The Use of Intermittent Intra-Operative Neural Monitoring in Reducing the Recurrent Laryngeal Nerve Palsy Rate in High-Risk ThyroidectomyChan Shun Yan Bryant, Cheng Ka Yu대한내분비외과학회 · Journal of Endocrine Surgery2021 · 제21권 제4호Technical Instructions for Continuous Intraoperative Neural Monitoring in Thyroid Surgery김훈엽, 채영준, Antonio Giacomo Rizzo, Che-Wei Wu, Gianlorenzo Dionigi, Hui Sun, Marcin Barczynski, Özer Makay, Vincenzo Bartolo대한내분비외과학회 · Journal of Endocrine Surgery2018 · 제18권 제1호

이 간행물의 다른 논문 (2건)