Dottore di ricerca

ciclo: XXXIII


ABSTRACT Background: Different technological innovations have been introduced in thyroid surgery over the last 50 years with the aim to guarantee major accuracy and decrease the risk of severe complications, such as permanent hypoparathyroidism and laryngeal nerve paralysis. Intraoperative nerve monitoring (IONM) of the recurrent laryngeal nerve (RLN) facilitate dissection, detect any type of nerve injury and predict the postoperative and functional nerve status. On the other hand, a microsurgical approach in thyroid surgery by using optical magnification is stated to increase the surgeon’s precision and RLNs could be identified with major accuracy. Among the literature, we found a wide series of systematic reviews and meta-analyses of studies comparing IONM versus direct visual RLN identification alone with controversial results. The aim of our study is to compare the technique of identification, preparation and dissection of the RLN in the course of total thyroidectomy with the aid of IONM against the use of optical magnification devices alone. Materials and Methods: In our prospective randomized longitudinal study, 100 patients undergoing total thyroidectomy between October 2018 and February 2020, were included in a cohort study e divided in two groups of 50 patients. The first group had surgery with the use of IONM (group IONM) and the second group with magnification binocular loupes (OM group). The influence of IONM and OM on the incidence of RLN paralysis and other surgical outcomes was analyzed, comparing the two groups and using multivariable regression analysis. Results: We performed 100 total thyroidectomies divided in two groups of 50 patients which were homogeneous in distribution of age, sex and type of thyroid disease at the admission. In the first group (IONM Group), the use of IONM was associated with a significant statistical difference regarding RLN paralysis rate of 4% versus 0% in the optical magnification group (OM Group). We reported also, statistically significant difference, in favor of the OM Group, in the operation time (mean 80,9 vs 105,37 min) and length of hospital staying (mean 2,04 vs 5,09 days). No statistically significant differences in the presence of hyperfunction or thyroiditis was shown. Regarding the histological report, surprisingly, the data on the presence of occult carcinomas in the two groups were relevant (37.5% in the OM Group and 25.53% in the IONM Group). Conclusion: To the best of our knowledge, this is the first study in the literature that directly compares the use of IONM with optical magnification alone in the prevention of RLN injuries. The IONM technique alone cannot be considered a substitute for the accurate visualization and identification of RLN, but it can add greater confidence to the surgeon, especially if less experienced. From our experience it emerges that both methods can be considered a standard in the future, at least in highly specialized endocrine-surgical centers. In addition, associating IONM with the use of magnification loupes and microsurgery technique we expect to find better outcomes. Further clinical studies, with a larger cohort of patients, are necessary to validate our results.

Produzione scientifica

11573/1670889 - 2022 - Intraoperative Neuromonitoring and Optical Magnification in the Prevention of Recurrent Laryngeal Nerve Injuries during Total Thyroidectomy
Karpathiotakis, M.; D'orazi, V.; Ortensi, A.; Biancucci, A.; Melcarne, R.; Borcea, M. C.; Scorziello, C.; Tartaglia, F. - 01a Articolo in rivista
rivista: MEDICINA (Basel: MDPI 2018- Kaunas; [Warsaw]: Lithuanian University of Health Sciences; 2014-2017 Kaunas: Lietuvos sveikatos mokslų universitetas, 2011) pp. - - issn: 1648-9144 - wos: WOS:000881079300001 (2) - scopus: 2-s2.0-85141601745 (3)

11573/1278344 - 2019 - May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score
D'orazi, Valerio; Sacconi, Andrea; Trombetta, Silvia; Karpathiotakis, Menelaos; Pichelli, Daniele; Di Lorenzo, Enrico; Ortensi, Alice; Urciuoli, Paolo; Biffoni, Marco; Ortensi, Andrea - 01a Articolo in rivista
rivista: BMC SURGERY (London: BioMed Central.) pp. - - issn: 1471-2482 - wos: WOS:000465561300007 (24) - scopus: 2-s2.0-85065882441 (27)

11573/1186586 - 2018 - Transoral video assisted thyroidectomy. A systematic review
Tartaglia, F; Maturo, A; Di Matteo, Filippo Maria; De Anna, L; Karpathiotakis, M; Pelle, F; Tromba, L; Carbotta, S; Carbotta, G; Biancucci, A; Galiffa, G; Livadoti, G; Falbo, F; Esposito, A; Donello, C; Ulisse, S. - 01g Articolo di rassegna (Review)
rivista: IL GIORNALE DI CHIRURGIA (CIC Edizioni Internazionali:Corso Trieste N 42, I 00198 Rome Italy:011 39 06 8412673, EMAIL:, INTERNET:, Fax: 011 39 06 8412688) pp. 276-283 - issn: 0391-9005 - wos: WOS:000456292600003 (20) - scopus: 2-s2.0-85055613208 (24)

11573/1562582 - 2016 - Pelvic floor anatomy
Karpathiotakis, Menelaos - 02a Capitolo o Articolo
libro: Management of fecal incontinence.Current treatment approaches and future perspectives - (9783319322247)

11573/956912 - 2016 - Fine needle aspiration cytology of 650 thyroid nodules operated for multinodular goiter: a cyto-histological correlation based on the new Italian cytological classification (siapec 2014)
Tartaglia, Francesco; Giuliani, A.; Tromba, Luciana; Carbotta, Sabino; Karpathiotakis, Menelaos; Tortorelli, Giovanni; Pelle, Fabio; Merola, Raffaele; Donello, Claudia; Carbotta, Giovanni; De Anna, Livia; Conzo, G.; Sorrenti, Salvatore; Ulisse, Salvatore - 01a Articolo in rivista
rivista: JOURNAL OF BIOLOGICAL REGULATORS & HOMEOSTATIC AGENTS (Wichtig Editore:Via Friuli 72 74, I 20135 Milan Italy:011 39 02 5455122, 011 39 2 55195443, EMAIL:, INTERNET:, Fax: 011 39 2 55195971) pp. 1187-1193 - issn: 0393-974X - wos: WOS:000392570300035 (20) - scopus: 2-s2.0-85015603054 (20)

11573/1562580 - 2015 - Traumatic cloaca; surgical treatment of a disabling deformity
Mongardini, Massimo; Karpathiotakis, Menelaos - 01m Editorial/Introduzione in rivista
rivista: JOURNAL OF AESTHETIC & RECONSTRUCTIVE SURGERY (Wilmington DE: iMed Pub LLC, 2015-) pp. - - issn: 2472-1905 - wos: (0) - scopus: (0)

11573/392910 - 2010 - [Treatment of obstructive defecation syndrome related to hedrocele. Our experience]
Mongardini, Massimo; Cola, Alessandra; Iachetta, Roberto Paolo; Giofre', Manuel; Karpathiotakis, Menelaos; Maturo, Alessandro; Custureri, Filippo - 01a Articolo in rivista
rivista: IL GIORNALE DI CHIRURGIA (CIC Edizioni Internazionali:Corso Trieste N 42, I 00198 Rome Italy:011 39 06 8412673, EMAIL:, INTERNET:, Fax: 011 39 06 8412688) pp. 502-506 - issn: 0391-9005 - wos: (0) - scopus: 2-s2.0-79952257188 (3)

© Università degli Studi di Roma "La Sapienza" - Piazzale Aldo Moro 5, 00185 Roma