Intraoperative neuromonitoring in thyroid surgery

Abstract

Abstract Background Intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery facilitates the identification of anatomical structures in cervical endocrine surgery reducing the frequency of vocal cord paralysis. Objective To study the normal electrophysiological values of the vague and recurrent laryngeal nerves before and after thyroid surgery. To compare rates of injury of recurrent nerve before and after the introduction of the intraoperative neuromonitoring in thyroid surgery. Material and methods An observational, descriptive and prospective study in which a total of 490 patients were included. Between 2003 and 2010, surgery was performed on 411 patients (703 nerves at risk) with systematic identification of recurrent laryngeal nerves. Between 2010 and 2011 neuromonitorisation was also systematically performed on 79 patients. Results Before the introduction of intraoperative neuromonitoring of 704 nerves at risk, there were 14 recurrent laryngeal nerve injuries. Since 2010, after the introduction of the intraoperative neuromonitoring in thyroid surgery, there has been no nerve injury in 135 nerves at risk. Conclusions We consider the systematic identification of the recurrent laryngeal nerve is the ‘gold standard’ in thyroid surgery and the intraoperative neuromonitoring of nerves can never replace surgery but can complement it.