DORIVAL DE CARLUCCI JUNIOR

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina

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Assunto: recurrent laryngeal nerve ×

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  • article 30 Citação(ões) na Scopus
    Negative and positive predictive values of nerve monitoring in thyroidectomy
    (2012) CERNEA, Claudio R.; BRANDAO, Lenine G.; HOJAIJ, Flavio C.; CARLUCCI JR., Dorival De; BRANDAO, Jose; CAVALHEIRO, Beatriz; SONDERMANN, Adriana
    Background Recurrent nerve injury is 1 of the most important complications of thyroidectomy. During the last decade, nerve monitoring has gained increasing acceptance in several centers as a method to predict and to document nerve function at the end of the operation. We evaluated the efficacy of a nerve monitoring system in a series of patients who underwent thyroidectomy and critically analyzed the negative predictive value (NPV) and positive predictive value (PPV) of the method. Methods. NIM System efficacy was prospectively analyzed in 447 patients who underwent thyroidectomy between 2001 and 2008 (366 female/81 male; 420 white/47 nonwhite; 11 to 82 years of age; median, 43 years old). There were 421 total thyroidectomies and 26 partial thyroidectomies, leading to 868 nerves at risk. The gold standard to evaluate inferior laryngeal nerve function was early postoperative videolaryngoscopy, which was repeated after 4 to 6 months in all patients with abnormal endoscopic findings. Results. At the early evaluation, 858 nerves (98.8%) presented normal videolaryngoscopic features after surgery. Ten paretic/paralyzed nerves (1.2%) were detected (2 unexpected unilateral paresis, 2 unexpected bilateral paresis, 1 unexpected unilateral paralysis, 1 unexpected bilateral paralyses, and 1 expected unilateral paralysis). At the late videolaryngoscopy, only 2 permanent nerve paralyses were noted (0.2%), with an ultimate result of 99.8% functioning nerves. Nerve monitoring showed absent or markedly reduced electrical activity at the end of the operations in 25/868 nerves (2.9%), including all 10 endoscopically compromised nerves, with 15 false-positive results. There were no false-negative results. Therefore, the PPV was 40.0%, and the NPV was 100%. Conclusions. In the present series, nerve monitoring had a very high PPV but a low NPV for the detection of recurrent nerve injury. (C) 2011 Wiley Periodicals, Inc. Head Neck 34: 175-179, 2012
  • article
    Practical tips to reduce complication rate in thyroidectomy
    (2017) CERNEA, Claudio; BRANDAO, Lenine G.; HOJAIJ, Flavio C.; CARLUCCI, Dorival De; VANDERLEI, Felipe; GOTODA, Renato; LEITE, Ana K.; KULCSAR, Marco A. V.; MATOS, Leandro L.; DEDIVITIS, Rogerio A.; ARAUJO-FILHO, Vergilius J. F.; TAVARES, Marcos R.
    Introduction: Thyroid cancer is the most frequent endocrine neoplasm, and its incidence has been consistently rising during the last decades. Surgical treatment is the choice, but the complications can be truly devastating. Methods: The objective of this article is to present some practical tips to reduce the complication rate in thyroid surgery. Results: The more frequent complications during a thyroidectomy are mentioned, as well as practical tips to try to prevent them: acute airway compression, nerve injuries (both inferior laryngeal and external branch of the superior laryngeal nerves), and hypoparathyroidism. Conclusion: The prevention of complications during a thyroidectomy is imperative. The only way that the surgeon can assure the safety is to strictly adhere to technical principles, with diligent hemostasis, thorough anatomical knowledge, and gentle handling of the anatomic structures adjacent to the thyroid gland.