Approach to signal loss in intraoperative nerve monitoring in thyroid surgery questionnaire: a Turkish surgical perspective
PurposeThis study aimed to evaluate surgeons’ use of intraoperative nerve monitoring (IONM) during thyroidectomy and their approach to loss of signal (LOS) in various clinical scenarios.Materials and MethodsA survey was conducted by the Turkish Endocrine Surgery Society on members of the Society in...
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| Language: | English |
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2025.1549988/full |
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| author | Yalin Iscan Irem Karatas Nurcihan Aygun Ahmet Cem Dural Serkan Teksoz Ozer Makay Ali Uğur Emre Fatih Tunca Mehmet Uludag Gökhan İçöz Yasemin Giles Senyürek Adnan Işgör Mehmet Haciyanli |
| author_facet | Yalin Iscan Irem Karatas Nurcihan Aygun Ahmet Cem Dural Serkan Teksoz Ozer Makay Ali Uğur Emre Fatih Tunca Mehmet Uludag Gökhan İçöz Yasemin Giles Senyürek Adnan Işgör Mehmet Haciyanli |
| author_sort | Yalin Iscan |
| collection | DOAJ |
| description | PurposeThis study aimed to evaluate surgeons’ use of intraoperative nerve monitoring (IONM) during thyroidectomy and their approach to loss of signal (LOS) in various clinical scenarios.Materials and MethodsA survey was conducted by the Turkish Endocrine Surgery Society on members of the Society in February 2020 and consisted of 16 questions. The practice of IONM use, rate of inclusion in informed consent texts, and attitudes of participants in case of signal loss were investigated. The study was conducted with 183 participants between February 4-12, 2020.ResultsMost participants (58.2%) had more than 10 years of surgical experience and 36.6% performed more than 50 thyroidectomies annually. IONM was routinely used by 78.7% of the participants, whereas 16.4% reserved its use in difficult cases. Only 5.2% of the participants performed continuous monitoring. In case-based LOS scenarios, the majority of participants (approximately 60%) terminated the operation when the nerve was anatomically intact but LOS persisted, except in high-risk cancer cases. When the nerve anatomy was disrupted, most participants terminated the surgery, except for the high-risk cancer group. In cases of irreversible LOS with preserved nerve integrity, 58.9% of the patients preferred continuous vagus stimulation on the contralateral side, whereas 41.1% preferred intermittent nerve monitoring. Although 68.2% of the participants verbally informed the patients about the risks of LOS, only 24.4% provided this information on the consent form.ConclusionThe use of IONM in thyroid surgery is increasing in our country. However, there is still no consensus on the approach for staged thyroidectomy in cases of signal loss, and institutional and individual differences persist. Further studies are needed to determine the medical-legal implications and effects of these variations. |
| format | Article |
| id | doaj-art-01d0a16d0ea541a3b68078fb4b604615 |
| institution | OA Journals |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Endocrinology |
| spelling | doaj-art-01d0a16d0ea541a3b68078fb4b6046152025-08-20T02:18:28ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-04-011610.3389/fendo.2025.15499881549988Approach to signal loss in intraoperative nerve monitoring in thyroid surgery questionnaire: a Turkish surgical perspectiveYalin Iscan0Irem Karatas1Nurcihan Aygun2Ahmet Cem Dural3Serkan Teksoz4Ozer Makay5Ali Uğur Emre6Fatih Tunca7Mehmet Uludag8Gökhan İçöz9Yasemin Giles Senyürek10Adnan Işgör11Mehmet Haciyanli12Division of Endocrine Surgery, Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, TürkiyeDepartment of General Surgery, Mardin Training and Research Hospital, Mardin, TürkiyeDivision of Endocrine Surgery, Department of General Surgery, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, TürkiyeDepartment of General Surgery, Faculty of Medicine, Istinye University, Istanbul, TürkiyeDivision of Endocrine Surgery, Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, TürkiyeDepartment of General Surgery, Ozel Saglik Hospital, Izmir, TürkiyeDepartmant of General Surgery, Anadolu Medical Center Hospital, Istanbul, TürkiyeDivision of Endocrine Surgery, Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, TürkiyeDivision of Endocrine Surgery, Department of General Surgery, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, TürkiyeDivision of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, TürkiyeDivision of Endocrine Surgery, Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, TürkiyeDepartment of General Surgery, Sisli Memorial Hospital, Istanbul, Türkiye0Departmant of General Surgery, Izmir Katip Celebi University, Atatürk Training And Research Hospital, Izmir, TürkiyePurposeThis study aimed to evaluate surgeons’ use of intraoperative nerve monitoring (IONM) during thyroidectomy and their approach to loss of signal (LOS) in various clinical scenarios.Materials and MethodsA survey was conducted by the Turkish Endocrine Surgery Society on members of the Society in February 2020 and consisted of 16 questions. The practice of IONM use, rate of inclusion in informed consent texts, and attitudes of participants in case of signal loss were investigated. The study was conducted with 183 participants between February 4-12, 2020.ResultsMost participants (58.2%) had more than 10 years of surgical experience and 36.6% performed more than 50 thyroidectomies annually. IONM was routinely used by 78.7% of the participants, whereas 16.4% reserved its use in difficult cases. Only 5.2% of the participants performed continuous monitoring. In case-based LOS scenarios, the majority of participants (approximately 60%) terminated the operation when the nerve was anatomically intact but LOS persisted, except in high-risk cancer cases. When the nerve anatomy was disrupted, most participants terminated the surgery, except for the high-risk cancer group. In cases of irreversible LOS with preserved nerve integrity, 58.9% of the patients preferred continuous vagus stimulation on the contralateral side, whereas 41.1% preferred intermittent nerve monitoring. Although 68.2% of the participants verbally informed the patients about the risks of LOS, only 24.4% provided this information on the consent form.ConclusionThe use of IONM in thyroid surgery is increasing in our country. However, there is still no consensus on the approach for staged thyroidectomy in cases of signal loss, and institutional and individual differences persist. Further studies are needed to determine the medical-legal implications and effects of these variations.https://www.frontiersin.org/articles/10.3389/fendo.2025.1549988/fullthyroid surgeryrecurrent laryngeal nerveintraoperative nerve monitoring (IONM)loss of signal (LOS)staged thyroidectomytotal thyroidectomy |
| spellingShingle | Yalin Iscan Irem Karatas Nurcihan Aygun Ahmet Cem Dural Serkan Teksoz Ozer Makay Ali Uğur Emre Fatih Tunca Mehmet Uludag Gökhan İçöz Yasemin Giles Senyürek Adnan Işgör Mehmet Haciyanli Approach to signal loss in intraoperative nerve monitoring in thyroid surgery questionnaire: a Turkish surgical perspective Frontiers in Endocrinology thyroid surgery recurrent laryngeal nerve intraoperative nerve monitoring (IONM) loss of signal (LOS) staged thyroidectomy total thyroidectomy |
| title | Approach to signal loss in intraoperative nerve monitoring in thyroid surgery questionnaire: a Turkish surgical perspective |
| title_full | Approach to signal loss in intraoperative nerve monitoring in thyroid surgery questionnaire: a Turkish surgical perspective |
| title_fullStr | Approach to signal loss in intraoperative nerve monitoring in thyroid surgery questionnaire: a Turkish surgical perspective |
| title_full_unstemmed | Approach to signal loss in intraoperative nerve monitoring in thyroid surgery questionnaire: a Turkish surgical perspective |
| title_short | Approach to signal loss in intraoperative nerve monitoring in thyroid surgery questionnaire: a Turkish surgical perspective |
| title_sort | approach to signal loss in intraoperative nerve monitoring in thyroid surgery questionnaire a turkish surgical perspective |
| topic | thyroid surgery recurrent laryngeal nerve intraoperative nerve monitoring (IONM) loss of signal (LOS) staged thyroidectomy total thyroidectomy |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2025.1549988/full |
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