Evidence map›Paper›PMID 27209315›Full record

ArticleLangenbeck's archives of surgery2017

Experience with intraoperative neuromonitoring of the recurrent laryngeal nerve improves surgical skills and outcomes of non-monitored thyroidectomy.

Beata Wojtczak, Krzysztof Sutkowski, Krzysztof Kaliszewski, Mateusz Głód, Marcin Barczyński

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Article in Langenbeck's archives of surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Beata WojtczakDepartment and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, M.C. Sklodowskiej 66, 50-369, Wrocław, Poland. beatawojtczak@wp.pl.
Krzysztof SutkowskiDepartment and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, M.C. Sklodowskiej 66, 50-369, Wrocław, Poland.
Krzysztof KaliszewskiDepartment and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, M.C. Sklodowskiej 66, 50-369, Wrocław, Poland.
Mateusz GłódDepartment and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, M.C. Sklodowskiej 66, 50-369, Wrocław, Poland.
Marcin BarczyńskiDepartment of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Kraków, Poland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeIntraoperative neuromonitoring (IONM) can serve as a tool to increase skills in recurrent laryngeal nerve (RLN) identification and complete removal of thyroid tissue. The aim of this study was to validate this hypothesis.

methodsThis prospective study involved 632 patients (1161 RLNs at risk) who underwent thyroid surgery in 2011-2014. Although IONM was not used until 2012, this prospective study started on 1 January 2011. The three participating surgeons knew about the study before that date and that the rate of RLN identification would be carefully measured in total and near-total surgery. Solely, visual identification of the RLN was used throughout 2011. IONM was introduced as a training tool in 2012-2014 for the first 3 months of each year. In the remaining months, thyroid operations were performed without IONM. Outcomes of non-monitored thyroid operations were compared before (01-12/2011) vs. after (04-12/2012-2014) 3 months of exposure to IONM yearly (01-03/2012-2014). The rate of RLN identification was assessed in total and near-total thyroidectomies and in totally resected lobes in Dunhill's operation. The prevalence of RLN injury and the utilization of total thyroidectomy were evaluated.

resultsIn 2011, the rate of successful RLN visual identification in total and near-total thyroidectomies and in totally resected lobes in Dunhill's operation was 45.71 %. After the introduction of IONM in 2012-2014, in the procedures performed without IONM, the rate was 86.66, 90.81, and 91.3 %. The prevalence of RLN injury in 2011 was 6.8 %, while in the years following the introduction of IONM, it was 3.61, 2.65, and 1.45 %. Utilization of total thyroidectomy increased from 47.9 % in 2011 to 100 % in 2014.

conclusionsExperience with IONM led to an increase in RLN identification (p < 0.0001), a decrease of RLN injury (p < 0.05), and an increase in the safe utilization of total thyroidectomy (p < 0.0001) in non-monitored thyroid operations. IONM is a valuable tool for surgical training.

Indexed as

Clinical CompetenceIntraoperative Neurophysiological MonitoringAdultAgedFemaleHumansIntraoperative ComplicationsLearning CurveMaleMiddle AgedPrevalenceProspective StudiesRecurrent Laryngeal Nerve InjuriesThyroid DiseasesThyroidectomyTreatment OutcomeIntraoperative neuromonitoringRecurrent laryngeal nerveSurgical skillThyroid surgery

Identifiers

PMID27209315
PMCPMC5437184

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.