Staged thyroidectomy: Time to consider intraoperative neuromonitoring as standard of care

摘要

Staged thyroidectomy is defined as a gland resection performed at two different times: the operation is at first limited to excision of the dominant lobe, the second side is removed later.In 1929, Pemberton first described modifications of the operative procedure that would improve the patient's condition at a reduced risk in Exophtlialmic Goiter: Indication for the Stage-Operation (1). This can be accomplished by resection of the gland in two stages (1). The operative risk of lobectomy is definitely less than that of subtotal thyroidectomy, for the surgical trauma and the chances of technical errors are just half those of the latter. If the patient can endure lobectomy, the resulting improvement will be so significant that the second lobe can be resected later at a greatly diminished hazard (1). Other reports of the stage procedure can be appraised from Porta (1811) and Blizzard, Billroth, Wolfler, Kocher, and Mayo (early 1900s) in the treatment of both benign and malignant thyroid disease (1).Intraoperative neuromonitoring (IONM) has gained widespread acceptance as an adjunct to the gold standard of visual recurrent laryngeal nerve (RLN) identification. However, it remains unclear whether IONM improves the clinical outcome of thyroidectomy in terms of preserved RLN function (2)