Loss of neuromonitoring signal during bilateral thyroidectomy: no systematic change in operative strategy according to a survey of the French Association of Endocrine Surgeons (AFCE)

Background: Total thyroidectomy presents a risk of bilateral vocal cord paralysis, which can lead to compromised airway. Visual Recurrent Laryngeal Nerve (RLN) identification significantly decreases this risk of RLN lesion. Yet, an anatomically intact nerve is not always functional. Intraoperative neuromonitoring (IONM) allows to test in real time the function of the RLN. In case of loss of signal (LOS) on the first operated side, some authors recommend to stop the intervention. The purpose of this study was to characterize the operative strategy of the French-speaking surgeons in case of LOS on the first side in planned bilateral thyroidectomies. Methods: An online questionnaire was sent to the surgeons of the French Association of Endocrine Surgeons (AFCE). Results: We collected 69 responses (response rate: 42 %). Forty-six surgeons (66 %) used IONM. After a signal loss, 22 % (N = 10) stopped the operation in all cases, 24 % (N = 11) continued the operation in case of malignant disease and stopped in cases of benign disease, and 54 % (N = 25) continued the operation contralaterally. Conclusions: The majority of surgeons continued the operation contralaterally as originally planned despite a loss of IONM signal at the end of the first side.