Intraoperative neuromonitoring (IONM) is used during thyroid surgery. Electromyographic signal is lost in the right recurrent laryngeal nerve (RLN) during dissection of the right lobe. The left lobe has not yet been resected. According to the International Neural Monitoring Study Group guidelines, what is the recommended action?
- A Stage the procedure: complete right lobe surgery, abandon left lobe resection, reassess vocal cord at 6-12 weeks ✓
- B Immediately complete the left lobectomy as planned to achieve total thyroidectomy
- C Convert to subtotal thyroidectomy leaving a small thyroid remnant on both sides
- D Proceed with left lobectomy only if the contralateral RLN signal is confirmed present
Explanation
INMSG guidelines recommend that when signal loss (indicating RLN injury) is confirmed on one side during staged or total thyroidectomy, the remaining contralateral lobe resection should be abandoned to prevent bilateral RLN injury and consequent life-threatening bilateral vocal cord paralysis and airway compromise. The staged approach (interval thyroidectomy) allows vocal cord function reassessment by laryngoscopy after 6-12 weeks; if function returns, the second procedure can be scheduled safely. This principle of staging protects the contralateral airway and is a key IONM-guided decision protocol.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.