Elsevier

Surgery

Volume 140, Issue 6, December 2006, Pages 866-873
Surgery

American Association of Endocrine Surgeons
The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: A comparative study on 1000 nerves at risk

Presented at the 27th Annual Meeting of the American Association of Endocrine Surgeons, New York, New York, May 2006.
https://doi.org/10.1016/j.surg.2006.07.017Get rights and content

Background

The role of intraoperative neuromonitoring of recurrent laryngeal nerve (RLN) during thyroidectomy has not been well established. The present study evaluates whether RLN injury can be reduced by the application of this technique during thyroidectomy in a single center.

Methods

Of 1000 RLNs that were at risk of injury in 639 consecutive patients who underwent thyroidectomy, the outcome of 501 RLNs with the use of neuromonitoring was compared with that of 499 nerves that were operated by routine identification only. The incidences of RLN paralysis were compared between the 2 groups and the assigned risk subgroups.

Results

Postoperative palsy was identified in 47 RLNs (4.7%), with complete recovery in 37 of 44 RLNs (84%) without documented injury. The overall incidence of postoperative RLN paralysis was significantly higher during thyroidectomy for malignancy (P = .025) and secondary thyroidectomy (P = .017). There was no significant difference in postoperative, transient, and permanent paralysis rates between the neuromonitoring and control groups. In subgroup analysis, the postoperative RLN palsy rate was higher during reoperative thyroidectomy (19% vs 4.6%; P = .019) in the control group but not in the neuromonitoring group (7.8% vs 3.8%; P > .05).

Conclusion

Neuromonitoring of the RLN during thyroid surgery could not be demonstrated to reduce RLN injury significantly, compared with the adoption of routine RLN identification. However, its application can be considered for selected high-risk thyroidectomies.

Section snippets

Patients and methods

Between January 2002 and August 2005, the cases of 639 of 647 consecutive patients who underwent thyroidectomy by a single surgical team were evaluated; the cases of patients with an intraoperative finding of tumor involvement of RLN (n = 8) were excluded. IONM was performed for 316 patients on the basis of the availability of the equipment and the choice of the operating surgeons (neuromonitoring group); 323 patients underwent thyroidectomies with routine identification of RLN only (control

Results

There were 133 men and 506 women with a mean age of 49 years (range, 8-93 years). The operative procedures included total or near-total thyroidectomy (n = 358 patients), unilateral lobectomy (n = 241 patients), completion total thyroidectomy (n = 36 patients), and subtotal thyroidectomy (n = 4 patients). Unilateral and bilateral procedures were performed in 277 and 362 patients, respectively, which accounted for 1000 nerves that were at risk after the exclusion of the RLN injured patients

Discussion

Despite being described for >3 decades,11, 12 IONM of RLN with electrical stimulation during thyroid surgical procedures has not gained widespread popularity until recently4, 8, 9, 10, 13, 14, 15, 16 because of the availability of a more user-friendly system and the demand of applying new surgical technology. Nerve monitoring has been developed to facilitate the identification of RLN, to map its contour, to avoid its iatrogenic injury, and to obtain prognostic information about postoperative

References (16)

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