Medico legal aspects on neuromonitoring in thyroid surgery: informed consent on malpractice claims. 2017

R Demontis, and M R Pittau, and A Maturo, and P Petruzzo, and G Calò

OBJECTIVE The purpose of this paper is to provide a forensic profile framework of neuromonitoring in thyroid surgery, regarding the information given to the patient and its classification as part of professional liability in the event of recurrent injury. METHODS Evaluation and reflections on the required behaviour of the surgeon on providing details on the operation before the informed consent is given and to outline the possible legal implications regarding professional liability as a result of recurrent injury. In particular, if it is an obligation to inform the patient about using this method and if it is possible for the surgeon to freely choose whether to employ this method, which is still burdened by a certain percentage of error and for that reason it cannot be defined a "standard of care". RESULTS To recognize neuromonitoring the role of standard of care in surgery of the thyroid means attribute a role of method able to avoid the surgeon to cause iatrogenic damage to the laryngeal nerve. For the foregoing reasons that is not true, determining false positives and false negatives, and this can be a double edged sword for the surgeon. CONCLUSIONS Although the progress in the field of thyroid surgery made in the last decade, currently there is no scientific reassuring evidence to completely avoid the possibility of producing an iatrogenic lesion of the laryngeal nerve. Information given to the patient prior to surgery should respect the requirements of completeness, freedom and honesty in order to allow the patient to self-determination.

UI MeSH Term Description Entries
D007258 Informed Consent Voluntary authorization, by a patient or research subject, with full comprehension of the risks involved, for diagnostic or investigative procedures, and for medical and surgical treatment. Consent, Informed
D008318 Malpractice Failure of a professional person, a physician or lawyer, to render proper services through reprehensible ignorance or negligence or through criminal intent, especially when injury or loss follows. (Random House Unabridged Dictionary, 2d ed) Professional Negligence,Negligence,Negligence, Professional,Professional Negligences
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013965 Thyroidectomy Surgical removal of the thyroid gland. (Dorland, 28th ed) Thyroidectomies
D061226 Recurrent Laryngeal Nerve Injuries Traumatic injuries to the RECURRENT LARYNGEAL NERVE that may result in vocal cord dysfunction. Recurrent Laryngeal Nerve Contusion,Recurrent Laryngeal Nerve Injury,Recurrent Laryngeal Nerve Transection,Recurrent Laryngeal Nerve Trauma,Recurrent Laryngeal Neuropathy, Traumatic
D064795 Intraoperative Neurophysiological Monitoring The systematic checking of the condition and function of a patient's CENTRAL NERVOUS SYSTEM during the course of a surgical operation. Intraoperative Neurophysiologic Monitoring,Intraoperative Neurophysiologic Monitorings,Monitoring, Intraoperative Neurophysiologic,Monitoring, Intraoperative Neurophysiological,Monitorings, Intraoperative Neurophysiologic,Neurophysiologic Monitoring, Intraoperative,Neurophysiologic Monitorings, Intraoperative,Neurophysiological Monitoring, Intraoperative

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