Abstract
BackgroundThe prevalence of recurrent laryngeal nerve (RLN) injury is higher in repeat than in primary thyroid operations. The use of intraoperative nerve monitoring (IONM) as an aid in dissection of the scar tissue is believed to minimize the risk of nerve injury. The aim of this study was to examine whether the use of IONM in thyroid reoperations can reduce the prevalence of RLN injury.MethodsThis was a retrospective cohort study of patients who underwent thyroid reoperations with IONM versus with RLN visualization, but without IONM. The database of thyroid surgery was searched for eligible patients (treated in the years 1993–2012). The primary outcomes were transient and permanent RLN injury. Laryngoscopy was used to evaluate and follow RLN injury.ResultsThe study group comprised 854 patients (139 men, 715 women) operated for recurrent goiter (n = 576), recurrent hyperthyroidism (n = 36), completion thyroidectomy for cancer (n = 194) or recurrent thyroid cancer (n = 48), including 472 bilateral and 382 unilateral reoperations; 1,326 nerves at risk (NAR). A group of 306 patients (500 NAR) underwent reoperations with IONM and 548 patients (826 NAR) had reoperations with RLN visualization, but without IONM. Transient and permanent RLN injuries were found respectively in 13 (2.6 %) and seven (1.4 %) nerves with IONM versus 52 (6.3 %) and 20 (2.4 %) nerves without IONM (p = 0.003 and p = 0.202, respectively).ConclusionsIONM decreased the incidence of transient RLN paresis in repeat thyroid operations compared with nerve visualization alone. The prevalence of permanent RLN injury tended to be lower in thyroid reoperations with IONM, but statistical validation of the observed differences requires a sample size of 920 NAR per arm.
Highlights
Thyroid reoperations can be challenging, even for a highly experienced thyroid surgeon, as visual identification of the recurrent laryngeal nerve (RLN) is more difficult during dissection of the scar tissues than in the virgin neck [1, 2]
The aim of this study was to examine whether the use of intraoperative nerve monitoring (IONM) in thyroid reoperations can reduce the prevalence of RLN injury
The prevalence of RLN injury is higher in repeat than in primary thyroid operations and it has been reported to approach 12.5 % for transient events and 3.8 % for permanent events [1,2,3,4,5,6,7,8,9,10,11]
Summary
Thyroid reoperations can be challenging, even for a highly experienced thyroid surgeon, as visual identification of the recurrent laryngeal nerve (RLN) is more difficult during dissection of the scar tissues than in the virgin neck [1, 2]. IONM is believed by many surgeons to aid in RLN dissection in the scar tissues of the neck, minimizing the risk of inadvertent. The prevalence of recurrent laryngeal nerve (RLN) injury is higher in repeat than in primary thyroid operations. The use of intraoperative nerve monitoring (IONM) as an aid in dissection of the scar tissue is believed to minimize the risk of nerve injury. The aim of this study was to examine whether the use of IONM in thyroid reoperations can reduce the prevalence of RLN injury
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