Key result
Intraoperative neuromonitoring is linked to ~100% fewer permanent recurrent laryngeal nerve injuries vs visualization alone.
Why the study?
The comparative effectiveness of intraoperative neuromonitoring versus visualization alone in reducing recurrent laryngeal nerve injury during thyroid surgery was unclear.
Does intraoperative neuromonitoring reduce postoperative recurrent laryngeal nerve injury in patients undergoing thyroid surgery?
Cohort (n=147)
No
Does intraoperative neuromonitoring reduce postoperative recurrent laryngeal nerve injury in patients undergoing thyroid surgery?
Absolute Event Rate: 0% vs 7.1%
p-value: p=0.044
Intraoperative neuromonitoring during thyroid surgery significantly reduces the incidence of permanent recurrent laryngeal nerve injury compared to visualization alone, without significantly increasing operation time.
IONM was associated with fewer permanent RLN injuries; leaves open whether RCTs will confirm benefit before changing practice.
UNLABELLED: Purpose/Aim of study: To compare the use of intraoperative neuromonitoring (IONM) versus visualization of the recurrent laryngeal nerve (RLN) alone in thyroid surgery with regard to incidence in postoperative RLN injury and operation time. MATERIALS AND METHODS: This retrospective cohort study was performed in the Amphia Hospital, the Netherlands. All thyroid gland operations were collected from September 2009 to October 2012. For each case we recorded the patient characteristics, indication for surgery, intraoperative data, complications, results of pathological evaluation, and consultation of a ENT-surgeon. Research of current literature and statistical analysis was performed. RESULTS: In total, 147 patients were included and classified into an IONM and non-IONM group. Both groups were similar in demographical aspects and indications for surgery. In total, we had 170 nerves at risk (NAR). In both groups, there were 85 (50%) NAR. Overall injury to the RLN was 6%. A statistical significant decrease of permanent RLN injuries was noticed in the IONM group compared to the non-IONM group (n = 0 vs n = 6; p = .044). In transient RLN injury, no difference was noticed (n = 2 vs n = 2). Operation time with or without IONM was not significantly different for hemithyroidectomies, neither for total thyroidectomies. CONCLUSION: IONM is a useful tool as an adjunct in thyroid surgery to prevent RLN injury. A statistical significant decrease in permanent RLN injury with the use of IONM was found, but it did not significantly decrease time of operation.
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Danschutter et al. (2014) conducted a cohort in Thyroid surgery (n=147). Intraoperative neuromonitoring (IONM) vs. Visualization of the recurrent laryngeal nerve (RLN) alone was evaluated on Permanent recurrent laryngeal nerve (RLN) injury (p=0.044). Intraoperative neuromonitoring during thyroid surgery significantly decreased permanent recurrent laryngeal nerve injuries compared to visualization alone (0% vs 7.1%; p=0.044).