Key result
Intraoperative nerve monitoring reduces recurrent laryngeal nerve injury ~32% versus visual identification during thyroidectomy.
Why the study?
The protective effect of intraoperative nerve monitoring (IONM) on recurrent laryngeal nerve injury during thyroidectomy remains controversial.
Does intraoperative nerve monitoring reduce recurrent laryngeal nerve injury in patients undergoing thyroidectomy?
Meta-Analysis
Does intraoperative nerve monitoring reduce recurrent laryngeal nerve injury in patients undergoing thyroidectomy?
Relative Risk: 0.68 (95% CI 0.55–0.83)
p-value: p=0.0002
Intraoperative nerve monitoring significantly reduces the risk of recurrent laryngeal nerve injury during thyroidectomy, particularly in bilateral and malignancy operations.
Supports adoption of intraoperative nerve monitoring in thyroidectomy; confirms benefit in Level 1 meta-analysis.
Recurrent laryngeal nerve (RLN) injury is an intractable complication of thyroidectomy. Intraoperative nerve monitoring (IONM) was designed to prevent RLN injury. However, the results concerning the protective effect of IONM on RLN injury are still controversial. We searched all eligible databases from 1980 to 2017. Meta-analysis was performed to evaluate the effect of IONM on RLN injury. Sensitivity analysis was also conducted to check the stability of our results. There were 34 studies included in the analysis. Overall analysis found a significant decrease in total injury (RR = 0.68, 95%CI: 0.55 to 0.83), transient injury (RR = 0.71, 95%CI: 0.57 to 0.88), and permanent injury (RD = -0.0026, 95%CI: -0.0039 to -0.0012) with IONM. Subgroup analysis found IONM played a preventive role of total, transient and permanent injury in patients undergoing bilateral thyroidectomy. IONM also reduced the incidence of total and transient injury for malignancy cases. Operations with IONM were associated with fewer total and transient RLN injuries in operation volume < 300 NARs per year and fewer total and permanent RLN injuries in operation volume ≥ 300 NARs per year. The application of IONM could reduce the RLN injury of thyroidectomy. Particularly, we recommend routine IONM for use in bilateral operations and malignancy operations.
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Bai et al. (2018) conducted a meta-analysis in Thyroidectomy. Intraoperative nerve monitoring (IONM) vs. Conventional visual identification was evaluated on Total recurrent laryngeal nerve (RLN) injury (RR 0.68, 95% CI 0.55 to 0.83, p=0.0002). Intraoperative nerve monitoring significantly reduced the incidence of total recurrent laryngeal nerve injury during thyroidectomy compared to conventional visual identification (RR 0.68).
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