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Thyroid surgery outcomes in a 4-year series with intraoperative neuromonitoring: a retrospective cohort study

2025-07-31Artigo de investigação Acesso aberto
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dc.contributor.authorAllen, Miguel
dc.contributor.authorPalma, Catarina
dc.contributor.authorBranco, Carlota
dc.contributor.authorResende, Cesar
dc.contributor.authorVieira, Natacha
dc.contributor.authorSilva, Ana Luísa
dc.contributor.authorRosário, Francisco Sobral do
dc.date.accessioned2025-09-04T15:27:35Z
dc.date.available2025-09-04T15:27:35Z
dc.date.issued2025-07-31
dc.description.abstractBackground: Meticulous surgical technique is essential for safe thyroid surgery, with high-volume surgeons experiencing the lowest complication rates. Intraoperative neuromonitoring (IONM) is increasingly adopted in high-volume centers to enhance outcomes and reduce complications. The aim of this study is to evaluate surgery outcomes during IONM introduction in daily practice. Methods: This retrospective cohort study evaluated morbidity associated with the introduction of IONM by analysing all consecutive thyroid surgeries performed between 2019 and 2022 at Hospital da Luz Lisboa. Patient demographics, clinical characteristics, and surgery-related data were collected. Primary outcomes were recurrent laryngeal nerve (RLN) palsy and annual progression of IONM use. Secondary outcomes included hypoparathyroidism and surgical complications. Results: A total of 502 patients (98 men and 404 women, with mean ages of 54.9 and 52.6 years, respectively) underwent either lobectomy or total thyroidectomy (TT), involving 719 RLNs at risk (RLNAR). A transient palsy rate of 0.56% and a definitive palsy rate of 0.28% were identified, with no associated risk factors. In the IONM group (n=237), transient RLN palsy occurred in 0.81% of patients, with no definitive palsy cases. IONM use increased from 35.9% in 2019 to 73.2% in 2022 (P<0.001). Permanent hypoparathyroidism occurred in 0.39% of patients. No cervical hematoma or surgical site infection was observed. Conclusions: The progressive implementation of IONM in thyroid surgery, alongside increasing case complexity and annual surgical volume, may support RLN preservation and reduce morbidity, while enabling gradual skill acquisition. Routine IONM use should be considered to improve patient outcomes, particularly in complex thyroid procedures.eng
dc.identifier.citationAllen, M., Palma, C., Branco, C., Resende, C., Vieira, N., Silva, A. L., & Rosário, F. S. D. (2025). Thyroid surgery outcomes in a 4-year series with intraoperative neuromonitoring: a retrospective cohort study. Gland Surgery, 14(7), 1230-1241. https://doi.org/10.21037/gs-2025-29
dc.identifier.doi10.21037/gs-2025-29
dc.identifier.eid105022276098
dc.identifier.issn2227-684X
dc.identifier.other8cb26aff-33d6-4b67-968e-8b3d86f1cb21
dc.identifier.pmcPMC12322754
dc.identifier.pmid40771371
dc.identifier.urihttp://hdl.handle.net/10400.14/54643
dc.identifier.wos001545897300008
dc.language.isoeng
dc.peerreviewedyes
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectEndocrine surgery
dc.subjectIntraoperative neuromonitoring (IONM)
dc.subjectRecurrent laryngeal nerve injury (RLN injury)
dc.subjectSurgical outcomes
dc.subjectThyroidectomy
dc.titleThyroid surgery outcomes in a 4-year series with intraoperative neuromonitoring: a retrospective cohort studyeng
dc.typeresearch article
dspace.entity.typePublication
oaire.citation.endPage1241
oaire.citation.issue7
oaire.citation.startPage1230
oaire.citation.titleGland Surgery
oaire.citation.volume14
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85

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