Role of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid and parathyroid surgery

Objective To investigate whether intraoperative neuromonitoring (IONM) has a significant advantage in reducing the incidence of recurrent laryngeal nerve (RLN) injury. Methods Patients who underwent thyroid and parathyroid surgery from October 2012 to December 2017 at the Center for Thyroid and Breast Surgery of Xuanwu Hospital were retrospectively analyzed. They were divided into the IONM group and visualization alone group (VA group) according to whether IONM was used. Results In total, 1696 nerves at risk of injury (IONM group, n = 1104; VA group, n = 592) were included in the analysis. Among the high-risk nerves, permanent damage occurred in no cases in the IONM group but in one case in the VA group. Because the higher proportion of central lymph node metastasis caused difficulties in central cervical lymph node dissection and identification of the RLN, the patients undergoing lateral cervical lymph node dissection in the VA group had a significantly higher risk of postoperative RLN injury (11.76% vs. 0.00%). Conclusion IONM technology has advantages in protection of the RLN, especially in high-risk nerves and patients with a high proportion of central lymph node metastasis who require central and lateral cervical lymph node dissection.

[1]  E. Kamer,et al.  Intraoperative nerve monitoring during thyroidectomy: evaluation of signal loss, prognostic value and surgical strategy. , 2019, Annals of the Royal College of Surgeons of England.

[2]  A. Arezzo,et al.  Intraoperative neuromonitoring versus visual nerve identification for prevention of recurrent laryngeal nerve injury in adults undergoing thyroid surgery. , 2016, The Cochrane database of systematic reviews.

[3]  K. Omori,et al.  Recurrent laryngeal nerve paralysis after thyroid cancer surgery and intraoperative nerve monitoring , 2018, The Laryngoscope.

[4]  C. Volteau,et al.  Does intraoperative neuromonitoring of recurrent nerves have an impact on the postoperative palsy rate? Results of a prospective multicenter study , 2018, Surgery.

[5]  K. Lorenz,et al.  Opportunities and challenges of intermittent and continuous intraoperative neural monitoring in thyroid surgery. , 2017, Gland surgery.

[6]  D. Kraus,et al.  Indications and extent of central neck dissection for papillary thyroid cancer: An American Head and Neck Society Consensus Statement , 2017, Head & neck.

[7]  K. Tomaszewski,et al.  The current state of intermittent intraoperative neural monitoring for prevention of recurrent laryngeal nerve injury during thyroidectomy: a PRISMA-compliant systematic review of overlapping meta-analyses , 2017, Langenbeck's Archives of Surgery.

[8]  Ben Ma,et al.  Systematic review with meta-analysis of intraoperative neuromonitoring during thyroidectomy. , 2017, International journal of surgery.

[9]  B. Lang,et al.  Systematic review and meta-analysis on intra-operative neuro-monitoring in high-risk thyroidectomy. , 2017, International journal of surgery.

[10]  G. Damiani,et al.  "The final countdown": Is intraoperative, intermittent neuromonitoring really useful in preventing permanent nerve palsy? Evidence from a meta-analysis. , 2016, Surgery.

[11]  D. Linos,et al.  Intraoperative Neuromonitoring in Thyroid Surgery: A Systematic Review , 2016, World Journal of Surgery.

[12]  R. Tubbs,et al.  Extralaryngeal branching of the recurrent laryngeal nerve: a meta-analysis of 28,387 nerves , 2016, Langenbeck's Archives of Surgery.

[13]  Bin Zhou,et al.  Intermittent intraoperative nerve monitoring in thyroid reoperations: Preliminary results of a randomized, single‐surgeon study , 2016, Head & neck.

[14]  G. Randolph,et al.  International survey on the identification and neural monitoring of the EBSLN during thyroidectomy , 2016, The Laryngoscope.

[15]  G. Zheng,et al.  Application experience of intraoperative neuromonitoring in thyroidectomy. , 2015, International journal of clinical and experimental medicine.

[16]  P. Cuvelier,et al.  Value of intra-operative neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy for benign goitre , 2015, The Journal of Laryngology & Otology.

[17]  S. Moritani.  Impact of lymph node metastases with recurrent laryngeal nerve invasion on patients with papillary thyroid carcinoma. , 2015, Thyroid : official journal of the American Thyroid Association.

[18]  R. Demontis,et al.  Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: experience of 2034 consecutive patients , 2014, Journal of Otolaryngology - Head & Neck Surgery.

[19]  A. Pisanu,et al.  Systematic review with meta-analysis of studies comparing intraoperative neuromonitoring of recurrent laryngeal nerves versus visualization alone during thyroidectomy. , 2014, The Journal of surgical research.

[20]  Shixing Zheng,et al.  Effect of intraoperative neuromonitoring on recurrent laryngeal nerve palsy rates after thyroid surgery--a meta-analysis. , 2013, Journal of the Formosan Medical Association = Taiwan yi zhi.

[21]  A. Sanabria,et al.  Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials , 2013, European Archives of Oto-Rhino-Laryngology.

[22]  R. Demontis,et al.  Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery: is it really useful? , 2013, La Clinica terapeutica.

[23]  M. Walz,et al.  Intraoperative Neuromonitoring does not Reduce the Incidence of Recurrent Laryngeal Nerve Palsy in Thyroid Reoperations: Results of a Retrospective Comparative Analysis , 2012, World Journal of Surgery.

[24]  A. Hubalewska-Dydejczyk,et al.  Clinical value of intraoperative neuromonitoring of the recurrent laryngeal nerves in improving outcomes of surgery for well-differentiated thyroid cancer. , 2011, Polski przeglad chirurgiczny.

[25]  T. Sloan,et al.  Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement , 2011, The Laryngoscope.

[26]  M. Barczyński,et al.  Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy , 2009, The British journal of surgery.

[27]  Johannes Haerting,et al.  Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. , 2004, Surgery.

[28]  C. Sekulla,et al.  Intraoperative neuromonitoring of surgery for benign goiter. , 2002, American journal of surgery.

[29]  T. Lindholm,et al.  Electrical stimulation of the human recurrent laryngeal nerve during thyroid operation. , 1969, Acta oto-laryngologica. Supplementum.

[30]  D. Shedd,et al.  Electrical identification of the recurrent laryngeal nerve. I. Response of the canine larynx to electrical stimulation of the recurrent laryngeal nerve. , 1966, Annals of surgery.

[31]  W. B. Hoover,et al.  INJURIES TO THE RECURRENT LARYNGEAL NERVE IN THYROID OPERATIONS: THEIR MANAGEMENT AND AVOIDANCE , 1938, Annals of surgery.