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Meta-Analysis
. 2023 Jul 1;109(7):2070-2081.
doi: 10.1097/JS9.0000000000000393.

Effectiveness of the recurrent laryngeal nerve monitoring during endoscopic thyroid surgery: systematic review and meta-analysis

Yu-Chen Liu  1 , Chuan-Lu Shen  2 , Zi-Yue Fu  2 , Yu-Chen Zhang  1 , Yan-Xun Han  1 , Bang-Jie Chen  3 , Yuan Jiang  1 , Si-Yue Yin  3 , Zhi Tao  1 , Shu-Yan Sheng  2 , Jian-Peng Wang  2 , Bing-Yu Liang  2 , Liang Zhang  1 , Dong Wang  1 , Kai-Le Wu  1 , Hai-Feng Pan  4 , Ye-Hai Liu  1
Affiliations
Meta-Analysis

Effectiveness of the recurrent laryngeal nerve monitoring during endoscopic thyroid surgery: systematic review and meta-analysis

Yu-Chen Liu et al. Int J Surg. .

Abstract

Background: Thyroid disease is a common endocrine disorder, and thyroid surgeries and postoperative complications have increased recently. This study aimed to explore the effectiveness of intraoperative nerve monitoring (IONM) in endoscopic thyroid surgery using subgroup analysis and determine confounding factors.

Materials and methods: Two researchers individually searched for relevant studies published till November 2022 in the PubMed, Embase, Web of Science and Cochrane Library databases. Eventually, eight studies met the inclusion criteria. Heterogeneity was assessed using the Cochran's Q test, and a funnel plot was implemented to evaluate publication bias. The odds ratio or risk difference were calculated using fixed-effects models. The weighted mean difference of continuous variables was calculated. Subgroup analysis was performed according to the disease type.

Results: Eight eligible papers included 915 patients and 1242 exposed nerves. The frequencies of transient, permanent and total recurrent laryngeal nerve (RLN) palsy were 2.64, 0.19 and 2.83%, respectively, in the IONM group and 6.15, 0.75 and 6.90%, respectively, in the conventional exposure group. In addition, analysis of the secondary outcome indicators for the average total length of surgery, localisation time of the RLN, recognition rate of the superior laryngeal nerve and length of incision revealed that IONM reduced the localisation time of the RLN and increased the identification rate of the superior laryngeal nerve. Subgroup analysis showed that IONM significantly reduced the incidence of RLN palsy in patients with malignancies.

Conclusions: The use of IONM significantly reduced the incidence of transient RLN palsy during endoscopic thyroid surgery, but it did not significantly reduce the incidence of permanent RLN palsy. However, the reduction in the total RLN palsy was statistically significant. In addition, IONM can effectively reduce the location time of the RLN and increase the recognition rate of the superior laryngeal nerve. Therefore, the application of IONM for malignant tumours is recommended.

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Conflict of interest statement

The authors have indicated they have no potential conflicts of interest to disclose.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article

Figures

Figure 1
Figure 1
A. Forest plot of the incidence of total recurrent laryngeal nerve palsy in the intraoperative nerve monitoring (IONM) and non-IONM groups during endoscopic thyroid surgery. B. Forest plot of the incidence of transient recurrent laryngeal nerve palsy in the IONM and non-IONM groups during endoscopic thyroid surgery. C. Forest plot of the incidence of permanent recurrent laryngeal nerve palsy in the IONM and non-IONM groups during endoscopic thyroid surgery.
Figure 2
Figure 2
A. Funnel plot of the incidence of total recurrent laryngeal nerve palsy in the intraoperative nerve monitoring (IONM) and non-IONM groups during endoscopic thyroid surgery. B. Funnel plot of the incidence of transient recurrent laryngeal nerve palsy in the IONM and non-IONM groups during endoscopic thyroid surgery. C. Funnel plot of the incidence of permanent recurrent laryngeal nerve palsy in the IONM and non-IONM groups during endoscopic thyroid surgery.
Figure 3
Figure 3
Forest plot of the surgery time in the intraoperative nerve monitoring (IONM) and non-IONM groups during endoscopic thyroid surgery.
Figure 4
Figure 4
Forest plot of the location time of RLN in the intraoperative nerve monitoring (IONM) and non-IONM groups during endoscopic thyroid surgery.
Figure 5
Figure 5
Forest plot of the length of incision in the intraoperative nerve monitoring (IONM) and non-IONM groups during endoscopic thyroid surgery.
Figure 6
Figure 6
Forest plot of the recognition rate of external branch of superior laryngeal nerve in the intraoperative nerve monitoring (IONM) and non-IONM groups during endoscopic thyroid surgery.
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