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The role of intraoperative nerve monitoring during thyroid surgery
A.Black1, 2, P.Dawes1, 2, K.Tomasdottir1
1Dunedin Public Hospital, 2Dunedin School of Medicine
Introduction
Recurrent laryngeal nerve injury (RLN) is a serious complication of thyroid surgery. Injury rates range from 1%-17%. Intraoperative nerve monitoring (IONM) has been proposed as a potential tool to reduce rates of RLN injury.
Aims
To evaluate whether or not the available evidence supports use of IONM in thyroid surgery, in regards to rates of RLN injury.
Methods
Google scholar, PubMed, The Cochrane Library and the University of Otago Library database were searched using the search terms thyroid surgery, thyroidectomy, intra-operative nerve monitoring, neuromonitoring and recurrent laryngeal nerve. Several studies were found, titles and abstracts were reviewed and fourteen studies were deemed relevant and reviewed in full.
Results
The majority were non-randomised comparative studies. One relevant randomised controlled trial (RCT) was identified. Generally the available evidence showed no statistically significant difference in rates of RLN palsy with or without IONM. Nerve visualisation and use of IONM was not conclusively shown to be superior to visualisation alone with regard to RLN injury. The evidence favours IONM when used during high risk and re-operations, particularly for decreasing rates of transient palsy. Improved outcomes were reported with increased experience using IONM, suggesting regular IONM usage is necessary to have an effect on outcome.
Conclusions
The role of IONM in thyroid surgery remains unclear and there is limited evidence to advocate for the routine use of IONM in all thyroid surgeries. Studies are inconsistent and there is lack of high quality and highly powered studies. Surgical experience as an influencing variable has not been adequately addressed. Routine use of IONM may result in improved outcomes.
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