METHODS: The International Neural Monitoring Study Group (INMSG) web-based survey was sent to 950 thyroid surgeons worldwide. The survey included information on the participants, IONM team/equipment/procedure, intraoperative/postoperative management of LOS, and management of LOS on the first side of thyroidectomy for benign and malignant disease.
RESULTS: Out of 950, 318 (33.5%) respondents completed the survey. Subgroup analyses were performed based on thyroid surgery volume: <50 cases/year (n = 108, 34%); 50 to 100 cases/year (n = 69, 22%); and >100 cases/year (n = 141, 44.3%). High-volume surgeons were significantly (P < .05) more likely to perform the standard procedures (L1-V1-R1-S1-S2-R2-V2-L2), to differentiate true/false LOS, and to verify the LOS lesion/injury type. When LOS occurs, most surgeons arrange otolaryngologists or speech consultation. When first-side LOS occurs, not all respondents decided to perform stage contralateral surgery, especially for malignant patients with severe disease (eg, extrathyroid invasion and poorly differentiated thyroid cancer).
CONCLUSIONS: Respondents felt that IONM was optimized when conducted under a collaborative team-based approach, and completed IONM standard procedures and management algorithm for LOS, especially those with high volume. In cases of first-site LOS, surgeons can determine the optimal management of disease-related, patient-related, and surgical factors. Surgeons need additional education on LOS management standards and guidelines to master their decision-making process involving the application of IONM.
方法:国际神经监测研究组(INMSG)基于网络的调查已发送给全球950名甲状腺外科医生。调查包括参与者的信息,IONM团队/设备/程序,术中/术后LOS的管理,良性和恶性甲状腺切除术第一侧LOS的处理。
结果:在950,318(33.5%)的受访者完成了调查。根据甲状腺手术量进行亚组分析:<50例/年(n=108,34%);50至100例/年(n=69,22%);和>100例/年(n=141,44.3%)。大批量外科医生(P<0.05)更有可能执行标准程序(L1-V1-R1-S1-S2-R2-V2-L2),为了区分真/假LOS,并验证LOS损伤/损伤类型。当LOS发生时,大多数外科医生会安排耳鼻喉科医生或言语咨询。当出现第一侧LOS时,并非所有受访者都决定进行对侧手术,特别是对于患有严重疾病的恶性患者(例如,甲状腺外浸润和低分化甲状腺癌)。
结论:受访者认为IONM在基于团队的协作方法下进行时得到了优化,并完成了IONM标准程序和LOS管理算法,尤其是那些体积大的。在第一站点LOS的情况下,外科医生可以确定疾病相关的最佳管理,患者相关,和手术因素。外科医生需要对LOS管理标准和准则进行额外的教育,以掌握其涉及IONM应用的决策过程。