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Review
. 2023 Sep 23;13(10):1429.
doi: 10.3390/jpm13101429.

Intraoperative Neuromonitoring Does Not Reduce the Risk of Temporary and Definitive Recurrent Laryngeal Nerve Damage during Thyroid Surgery: A Systematic Review and Meta-Analysis of Endoscopic Findings from 73,325 Nerves at Risk

Anna Teresa Cozzi  1 , Alice Ottavi  1 , Paolo Lozza  1 , Alberto Maccari  1 , Roberto Borloni  1 , Letizia Nitro  1 , Elena Giulia Felisati  1 , Andrea Alliata  1 , Barbara Martino  1 , Giancarlo Cacioppo  1 , Manuela Fuccillo  1 , Cecilia Rosso  1 , Carlotta Pipolo  1 , Giovanni Felisati  1 , Loredana De Pasquale  2 , Alberto Maria Saibene  1
Affiliations
Review

Intraoperative Neuromonitoring Does Not Reduce the Risk of Temporary and Definitive Recurrent Laryngeal Nerve Damage during Thyroid Surgery: A Systematic Review and Meta-Analysis of Endoscopic Findings from 73,325 Nerves at Risk

Anna Teresa Cozzi et al. J Pers Med. .

Abstract

Background: While intraoperative neuromonitoring (IONM) helps the early identification of recurrent laryngeal nerve (RLN) damage, IONM's role in RLN damage prevention is not defined, given the lack of large studies on the subject.

Methods: In a PRISMA-compliant framework, all original thyroid surgery prospective studies providing early postoperative endoscopic data for all patients were pooled in a random-effects meta-analysis. We compared the temporary (and definitive where available) RLN damage rates according to IONM use and IONM type (intermittent, I-IONM, or continuous, C-IONM).

Results: We identified 2358 temporary and 257 definitive RLN injuries in, respectively, 73,325 and 66,476 nerves at risk. The pooled temporary and definitive RLN injury rates were, respectively, 3.15% and 0.422% considering all procedures, 3.29% and 0.409% in cases using IONM, and 3.16% and 0.463 in cases not using IONM. I-IONM and C-IONM, respectively, showed a pooled temporary RLN injury rate of 2.48% and 2.913% and a pooled definitive injury rate of 0.395% and 0.4%. All pooled rates had largely overlapping 95% confidence intervals.

Conclusions: Our data suggest that IONM does not affect the temporary or definitive RLN injury rate following thyroidectomy, though its use can be advised in selected cases and for bilateral palsy prevention.

Keywords: adverse event; hoarseness; lobectomy; thyroidectomy; vocal folds palsy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA-style flowchart of article selection through the systematic review and meta-analysis process.
See this image and copyright information in PMC

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