Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: experience of 2034 consecutive patients.

Abstract

BACKGROUND:

The aim of this study was to evaluate the ability of intraoperative neuromonitoring in reducing the postoperative recurrent laryngeal nerve palsy rate by a comparison between patients submitted to thyroidectomy with intraoperative neuromonitoring and with routine identification alone.

METHODS:

Between June 2007 and December 2012, 2034 consecutive patients underwent thyroidectomy by a single surgical team. We compared patients who have had neuromonitoring and patients who have undergone surgery with nerve visualization alone. Patients in which neuromonitoring was not utilized (Group A) were 993, patients in which was utilized (group B) were 1041.

RESULTS:

In group A 28 recurrent laryngeal nerve injuries were observed (2.82%), 21 (2.11%) transient and 7 (0.7%) permanent. In group B 23 recurrent laryngeal nerve injuries were observed (2.21%), in 17 cases (1.63%) transient and in 6 (0.58%) permanent. Differences were not statistically significative.

CONCLUSIONS:

Visual nerve identification remains the gold standard of recurrent laryngeal nerve management in thyroid surgery. Neuromonitoring helps to identify the nerve, in particular in difficult cases, but it did not decrease nerve injuries compared with visualization alone. Future studies are warranted to evaluate the benefit of intraoperative neuromonitoring in thyroidectomy, especially in conditions in which the recurrent nerve is at high risk of injury.

• Authors: Pietro Giorgio Calò, Giuseppe Pisano, Fabio Medas, Maria Rita Pittau, Luca Gordini, Roberto Demontis, Angelo Nicolosi
• Journal: Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale (J Otolaryngol Head Neck Surg) Vol. 43 Pg. 16 (Jun 18 2014) ISSN: 1916-0216 [Electronic] England
• PMID: 24942225 (Publication Type: Comparative Study, Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cross-Sectional Studies
• Female
• Humans
• Intraoperative Complications (diagnosis, epidemiology, physiopathology, prevention & control)
• Intraoperative Neurophysiological Monitoring
• Lymph Node Excision
• Male
• Middle Aged
• Predictive Value of Tests
• Recurrent Laryngeal Nerve (physiopathology)
• Recurrent Laryngeal Nerve Injuries (diagnosis, epidemiology, physiopathology, prevention & control)
• Retrospective Studies
• Thyroid Diseases (surgery)
• Thyroid Neoplasms (surgery)
• Thyroidectomy
• Young Adult