PDF(Pubmed)
Abstract：
BACKGROUND: The aim of this study is to describe the management and associated follow-up strategies adopted by thyroid surgeons with different surgical volumes when loss of signal (LOS) occurred on the first side of planned bilateral thyroid surgery, and to further define the consensus on intraoperative neuromonitoring (IONM) applications.
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.
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.
摘要：
背景：本研究的目的是描述当计划的双侧甲状腺手术的第一侧发生信号丢失（LOS）时，甲状腺外科医生在不同手术量下采用的管理和相关随访策略，并进一步定义术中神经监测（IONM）应用的共识。
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。
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。
