Effect of intraoperative neuromonitoring on recurrent laryngeal nerve palsy rates after thyroid surgery--a meta-analysis

Abstract

Background/purpose: Though intraoperative nerve monitoring (IONM) during thyroid surgery has gained universal acceptance for localizing and identifying the recurrent laryngeal nerve (RLN), its role in reducing the rate of RLN injury remains controversial. In order to assess the effect of IONM during thyroid surgery, its value in reducing the incidence of RLN palsy was systematically evaluated.

Methods: Studies were evaluated for inclusion in this analysis by researching PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the references of included studies. The initial screening of article titles and abstracts was independently performed by five reviewers based on the research protocol criteria. Each article was then read in detail and discussed before inclusion in the meta-analysis. Data were independently extracted, including the level of evidence, number of at-risk nerves, allocation method, baseline equivalence between groups, definitions of transient and permanent vocal fold palsy, systematic application of electrodes, etc. The meta-analysis was then performed. Odds ratios were pooled using a random effects model.

Results: Five randomized clinical trials and 12 comparative trials evaluating 36,487 at-risk nerves were included. Statistically significant differences in terms of total recurrent laryngeal nerve palsy (3.37% with intraoperative nerve monitoring [IONM] vs. 3.76% without IONM [OR: 0.74; 95% confidence interval [CI]: 0.59-0.92]) and transient recurrent laryngeal nerve palsy (2.56% with IONM vs. 2.71% without IONM [OR: 0.80; 95% CI: 0.65-0.99]) were identified. The persistent incidence of recurrent laryngeal nerve palsy was 0.78% for IONM versus 0.96% for nerve identification alone (OR: 0.80; 95% CI: 0.62-1.03).

Conclusion: Based on this meta-analysis, statistically significant differences were determined in terms of the incidences of total and transient recurrent laryngeal nerve palsy after using IONM versus recurrent laryngeal nerve identification alone during thyroidectomy. However, no statistically significant differences were identified regarding the incidence of persistent recurrent laryngeal nerve palsy between groups.

Keywords: neuromonitoring; paralysis; paresis; recurrent laryngeal nerve; thyroidectomy.