Ramazan Gündoğdu, Serkan Erkan, Fatma Çaylaklı, Murat Kuş, Tevfik Avcı, Hakan Yabanoğlu

TİROİDEKTOMİDE İNTRAOPERATİF NÖROMONİTÖRİZASYON RUTİN KULLANILMALI MI?

Amaç: Tiroidektomi sonrasında en korkulan komplikasyon rekürren larengeal sinir (RLS) hasarıdır. Bu cerrahide intraoperatif nöro- monitörizasyonun (İONM) kullanımının etkinliği henüz net değildir. Bu çalışmada tiroidektomi uygulanan hastalarda İONM ile peroperatif indirekt laringoskopi bulguları arasındaki anatomik ve fizyolojik korelasyonu değerlendirerek; İONM’un sensitivitesini ve rutin kullanımının gerekliliğini tartışmayı amaçladık. Yöntemler: 12.2020-10.2021 tarihleri arasında merkezimizde tiroidektomi yapılan hastaların verileri ileriye dönük olarak kaydedildi ve ardışık 79 hasta çalışmaya dahil edildi. İndirekt laringoskopi ameliyat öncesi ve ameliyat sonrası ilk gün yapıldı. Hastaların endikasyonlarına göre tiroidektomi yapıldı ve rutin olarak İONM kullanıldı. Ameliyat sonrası laringoskopik bulguları olanlara; 180. günde kontrol laringoskopi yapıldı. İONM'nin RLS hasarını saptamadaki sensitivitesi, laringoskopide vokal kord hasarı olan olguların intraoperatif bulguları ile korelasyonu değerlendirilerek belirlendi. Bulgular: Çalışmaya alınan hastaların 64’ü (%81) kadındı. Postoperatif birinci gün laringoskopisinde vokal kord patolojisi saptanan 11 hasta vardı. Bu hastaların yalnızca dördünde İONM bulgusu vardı ve İONM’nin RLS hasarını saptamadaki sensitivitesi %36,3 olarak saptandı. Sonuç: Deneyimi yüksek merkezlerde ek cerrahi prosedür içermeyen, primer tiroid cerrahisi uygulanacak hastalar için, İONM’un zorunlu ihtiyaç olarak görülmemesi gerektiği düşüncesindeyiz.

SHOULD INTRAOPERATIVE NEUROMONITORING BE USED ROUTİNELY IN THYROIDECTOMY?

Aim: The most feared complication after thyroidectomy is recurrent laryngeal nerve (RLS) injury. The effectiveness of the use of intraoperative neuromonitoring (IONM) in this surgery is not yet clear. In this study, by evaluating the anatomical and physiological correlation between IONM and perioperative indirect laryngoscopy findings in patients who underwent thyroidectomy; We aimed to discuss the sensitivity of IONM and the necessity of its routine use. Methods: The data of patients who underwent thyroidectomy in our center between 12.2020-10.2021 were prospectively recorded. A total of 79 consecutive patients were included in the study. Indirect laryngoscopy was performed preoperatively and on the first postoperative day. Thyroidectomy was performed according to the indications of the patients and IONM was routinely used. Those with post-operative laryngoscopic findings; Control laryngoscopy was performed on day 180. The sensitivity of IONM in detecting RLN damage was determined by evaluating the correlation with the intraoperative findings of cases with vocal cord damage in laryngoscopy. Results: 64 (81%) of the patients included in the study were women. There were 11 patients with vocal cord pathology in the laryngoscopy on the first postoperative day. Only four of these patients had IONM findings and the sensitivity of IONM in detecting RLN damage was 36.3%. Conclusions: We think that IONM should not be considered as a mandatory requirement for patients who will undergo primary thyroid surgery without additional surgical procedures in centers with high experience.

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