Optimal Monitoring Technology for Pediatric Thyroidectomy

Simple Summary Pediatric thyroid surgery is an increasing treatment option for children with thyroid cancer, thyroid nodules, or other thyroid diseases unresponsive to medical treatments. Intraoperative neural monitoring in adults as well as in children proves to be very helpful in preserving the functionality of the recurrent laryngeal nerve. This neural monitoring, which can be carried out with intermittent or continuous (automatic and periodic) stimulation, is of considerable importance in patients aged under 18 years, who are more likely to suffer injuries due to the anatomical features of the recurrent laryngeal nerve itself, which is harder to identify since it is thinner. This retrospective study aimed to describe, firstly, characteristics and outcomes of the intraoperative neural monitoring technology in the pediatric population, and secondarily the recurrent laryngeal nerve complication rate. Thirty-seven patients (age <18 years) operated on from 2015 to 2021 by conventional open thyroid surgery were included. Twenty-four (64.9%) total thyroidectomies and 13 (35.1%) lobectomies were performed. Seven central and six lateral lymph node dissections completed 13 bilateral procedures. Histology showed malignancy in 45.9% of the cases. The differences between the electromyographic profiles of endotracheal tubes or electrodes for continuous monitoring were not statistically significant. In our series of young patients, both adhesive (even in 4- or 5-year-olds) and embedded endotracheal tubes were used, while in patients 3 years old or younger, the use of a more invasive detection method with transcartilage placement recording electrodes was required. Overall, out of 61 total at-risk nerves, 5 (8.2%) recurrent laryngeal nerves were injured with consequent intraoperative loss of the signal; however, all these lesions were transient, restoring their normal functionality within 4 months from surgical procedure. To our knowledge, this is the first study of intraoperative neural monitoring management in a cohort of Italian pediatric patients.