背景:喉返神经(RNL)鉴定是甲状腺切除术的标准。术中神经监测(IONM)已被引入作为RLN功能评估的补充工具。这项研究的目的是确定常规使用IONM如何影响甲状腺切除术中的学习曲线(LC)。
方法:在2所学术医院的学习曲线课程中,由手术住院医师进行甲状腺全切除术的患者,分为两组:A组,包括由3名不同的居民在没有IONM的情况下进行的150例甲状腺切除术,B组,包括150个常规使用间歇性IONM的程序,其他三个不同的居民。通过比较手术时间(OT)来测量LC,它在LC发展过程中的稳定,围手术期并发症发生率。
结果:如前所述,LC是在30次手术后完成的,在这两组中,由于IONM的使用而没有差异。同样,两组间无显著性差异,亚组之间独立匹配,对于OT和并发症,即使比较RLN麻痹。直接神经可视化和IONM评估率在所有组中具有可比性,并且没有报告双侧RLN麻痹(短暂性或永久性)。无一例单侧肺叶切除术中断手术,由于RLN受伤的证据,已报告。
结论:研究表明,使用IONM甲状腺手术,尽管需要对经验丰富的外科医生进行专门的培训,不会特别影响接近这种手术的居民的学习曲线,因此,即使对于受训人员,也应鼓励其常规使用。
BACKGROUND: Recurrent laryngeal nerve (RNL) identification constitutes the standard in thyroidectomy. Intraoperative nerve monitoring (IONM) has been introduced as a complementary tool for RLN functionality evaluation. The aim of this study is to establish how routine use of IONM can affect the learning curve (LC) in thyroidectomy.
METHODS: Patients undergoing total thyroidectomy performed by surgery residents in their learning curve course in 2 academic hospitals, were divided into 2 groups: Group A, including 150 thyroidectomies performed without IONM by 3 different residents, and Group B, including 150 procedures with routine use of intermittent IONM, by other 3 different residents. LC was measured by comparing operative time (OT), its stabilization during the development of the LC, perioperative complication rate.
RESULTS: As previously demonstrated, the LC was achieved after 30 procedures, in both groups, with no differences due to the use of IONM. Similarly, there were no significant differences among the 2 groups, and between subgroups independently matched, for both OT and complications, even when comparing RLN palsy. Direct nerve visualization and IONM assessment rates were comparable in all groups, and no bilateral RLN palsy (transient or permanent) were reported. No case of interrupted procedure to unilateral lobectomy, due to evidence of RLN injury, was reported.
CONCLUSIONS: The study demonstrates that the use of IONM thyroid surgery, despite requiring a specific training with experienced surgeons, does not particularly affect the learning curve of residents approaching this kind of surgery, and for this reason its routine use should be encouraged even for trainees.