Recurrent laryngeal nerve injury assessment by intraoperative laryngeal ultrasonography: a prospective diagnostic test accuracy study

Andrius Rybakovas; Augustinas Bausys; Andrius Matulevicius; Gytis Zaldokas; Mindaugas Kvietkauskas; Gintautas Tamulevicius; Virgilijus Beisa; Kestutis Strupas

doi:10.5114/wiitm.2018.80066

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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Original paper

Recurrent laryngeal nerve injury assessment by intraoperative laryngeal ultrasonography: a prospective diagnostic test accuracy study

Andrius Rybakovas

,

Augustinas Bausys

,

Andrius Matulevicius

,

Gytis Zaldokas

,

Mindaugas Kvietkauskas

,

Gintautas Tamulevicius

,

Virgilijus Beisa

,

Kestutis Strupas

Videosurgery Miniinv 2019; 14 (1): 38–45

DOI: https://doi.org/10.5114/wiitm.2018.80066

Online publish date: 2018/12/10

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AMA

Rybakovas A, Bausys A, Matulevicius A, et al. Recurrent laryngeal nerve injury assessment by intraoperative laryngeal ultrasonography: a prospective diagnostic test accuracy study. Videosurgery and Other Miniinvasive Techniques. 2019:38-45. doi:10.5114/wiitm.2018.80066.

APA

Rybakovas, A., Bausys, A., Matulevicius, A., Zaldokas, G., Kvietkauskas, M.,  & Tamulevicius, G. et al. (2019). Recurrent laryngeal nerve injury assessment by intraoperative laryngeal ultrasonography: a prospective diagnostic test accuracy study. Videosurgery and Other Miniinvasive Techniques, 38-45. https://doi.org/10.5114/wiitm.2018.80066

Chicago

Rybakovas, Andrius, Augustinas Bausys, Andrius Matulevicius, Gytis Zaldokas, Mindaugas Kvietkauskas, Gintautas Tamulevicius,  and Virgilijus Beisa et al. 2019. "Recurrent laryngeal nerve injury assessment by intraoperative laryngeal ultrasonography: a prospective diagnostic test accuracy study". Videosurgery and Other Miniinvasive Techniques: 38-45. doi:10.5114/wiitm.2018.80066.

Harvard

Rybakovas, A., Bausys, A., Matulevicius, A., Zaldokas, G., Kvietkauskas, M., Tamulevicius, G., Beisa, V.,  and Strupas, K. (2019). Recurrent laryngeal nerve injury assessment by intraoperative laryngeal ultrasonography: a prospective diagnostic test accuracy study. Videosurgery and Other Miniinvasive Techniques, pp.38-45. https://doi.org/10.5114/wiitm.2018.80066

MLA

Rybakovas, Andrius et al. "Recurrent laryngeal nerve injury assessment by intraoperative laryngeal ultrasonography: a prospective diagnostic test accuracy study." Videosurgery and Other Miniinvasive Techniques, 2019, pp. 38-45. doi:10.5114/wiitm.2018.80066.

Vancouver

Rybakovas A, Bausys A, Matulevicius A, Zaldokas G, Kvietkauskas M, Tamulevicius G et al. Recurrent laryngeal nerve injury assessment by intraoperative laryngeal ultrasonography: a prospective diagnostic test accuracy study. Videosurgery and Other Miniinvasive Techniques. 2019:38-45. doi:10.5114/wiitm.2018.80066.

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Introduction
Recurrent laryngeal nerve injury is one of the major complications related to thyroid surgery. Intraoperative recurrent laryngeal nerve functional status monitoring is becoming a standard part of thyroid surgery. However, the current methods for intraoperative nerve functional status assessment are associated with a demand for specialized devices and increased costs.

Aim
To assess the validity of a new method – intraoperative laryngeal ultrasonography – for prediction of recurrent laryngeal nerve injury.

Material and methods
This prospective diagnostic test accuracy study included 112 patients undergoing thyroid surgery in Vilnius University Hospital Santaros Clinics. Neurostimulation combined with laryngeal ultrasonography and laryngeal palpation was performed intraoperatively to evaluate recurrent laryngeal nerve functional status. Recurrent laryngeal nerve injury was confirmed by laryngoscopy, which was performed on the first postoperative day and considered to be the gold standard method.

Results
Data on 112 consecutive patients and 200 nerves at risk were collected. The temporary vocal cord palsy rate was 5.4% per patient and 3% per nerve at risk. No permanent palsy or bilateral injury cases were registered in the study cohort. Laryngeal ultrasound sensitivity counted per nerve at risk was 83.3%, specificity 97.2%, accuracy 96.4%, positive predictive value 62.5% and negative predictive value 99%.

Conclusions
Laryngeal ultrasonography is a feasible new technique for accurate intraoperative recurrent laryngeal nerve injury evaluation.

keywords:

Recurrent laryngeal nerve injury assessment by intraoperative laryngeal ultrasonography: a prospective diagnostic test accuracy study

Andrius Rybakovas , Augustinas Bausys , Andrius Matulevicius , Gytis Zaldokas , Mindaugas Kvietkauskas , Gintautas Tamulevicius , Virgilijus Beisa , Kestutis Strupas

thyroid surgery, recurrent laryngeal nerve, vocal cord palsy, laryngeal ultrasound

Andrius Rybakovas

,

Augustinas Bausys

,

Andrius Matulevicius

,

Gytis Zaldokas

,

Mindaugas Kvietkauskas

,

Gintautas Tamulevicius

,

Virgilijus Beisa

,

Kestutis Strupas