Introduction: Paresis of the recurrent laryngeal nerve (RLN) is a complication of thyroid surgery. Neuromonitoring as is gaining acceptance among
surgeons. The aim of the study was to assess the number of technical problems in the initial phase of intraoperative neuromonitoring (IONM) use and
the specificity, sensitivity, positive predictive value and negative predictive
value of neuromonitoring. The number of cases of postoperative paresis
(transient and permanent) was assessed.
Material and methods: The prospective analysis included 101 thyroid operations with IONM (190 RLNs at risk of injury) in the period from January to
April, 2012. Demographic data, rate of RLN identification, sensitivity, specificity and predictive value of the method, the duration of the procedurę and
the percentage of RLN paresis were considered.
Results: The RLN was identified in 92% of the cases. Technical problems
were observed in 12.98%, of which 61% were due to incorrect positioning of
the endotracheal tube electrodes in relation to the vocal cords. The sensitivity, specificity, negative and positive predictive value and the accuracy of
the method were respectively 71%, 98%, 62.5%, 98.9% and 97%. Early nerve
injury occurred in 3.7% of the cases; 2.6% were temporary paresis and 1.1%
permanent.
Conclusions: During the initial stages of implementing IONM we experienced technical problems that required correction in every tenth patient.
The positive predictive value was relatively low; nevertheless, good results
in terms of the rate of accurate identification of the RLN as well as the low
rate of RLN paresis support the use of this method.
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