Systematic review with meta-analysis of studies comparing intraoperative neuromonitoring of recurrent laryngeal nerves versus visualization alone during thyroidectomy

Recurrent laryngeal nerve injury (RLNI) in thyroid surgery and its prevention

“…20 However, there is no significant difference in incidence of nerve injury between intra operative nerve identification and visualisation of the nerve alone. 21 The potential for recovery is generally proportional to the degree of injury, although clinical factors such as unrecognized severity of injury and delay in the diagnosis have precluded establishing an exact relation. This principle underlies the policy of watchful waiting in certain surgical etiologies, where nerve is known or even suspected to be intact.…”

The Recurrent Laryngeal Nerve and Thyroid Surgery; Who to Scope, When to Visualize, Who to Stimulate

“…There were no statistically significant differences between the groups. For the subgroup analysis comparing transient and persistent cord palsy among high risk patients, no difference was found (5). The findings of these systematic reviews and meta analyses conclude that the use of intra-operative nerve monitoring does not reduce the incidence of recurrent laryngeal nerve injury when compared to visualization alone.…”

“…Permanent injury is diagnosed after 12 months of persistent palsy (4). Permanent injury will occur in 0-6% of surgeries while transient injury/palsy occurs in 3-12% (1,4,5). The mechanisms of injury vary including ligation, traction, clamping, diathermy and ischemia (4).…”

Surgical Risk after Unilateral Lobectomy versus Total Thyroidectomy: A Review of 47,434 Patients

“…While a systematic review with meta-analysis showed no statistically significant difference in the incidence of recurrent laryngeal nerve palsy when using intraoperative nerve monitoring versus visualization alone during thyroidectomy, the technique of intraoperative neuromonitoring in thyroid surgery has high accuracy, specificity, sensitivity and negative predictive value in excluding postoperative recurrent laryngeal nerve palsy, and is very commonly used in thyroid surgery [33,34].…”