Abstract
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.
Highlights
Intraoperative nerve monitoring (IONM) is designed to reduce the incidence of Recurrent laryngeal nerve (RLN) injury, the effect of IONM on RLN injury prevention in thyroid surgery is still controversial[12,13]
We excluded 24 from these 58 articles because of monitoring other nerve (5 articles), no control group (10 articles), incomplete data for Nerve at risk (NAR) (6 articles), or duplicated data derived from same center (3 articles) (Fig. 1)[34]
Overall meta-analysis found a significant decrease of total RLN injury (RR = 0.68, 95%confidence interval (CI): 0.55 to 0.83; p = 0.0002), transient injury (RR = 0.71, 95%CI: 0.57 to 0.88; p = 0.0017), and permanent injury (RD = −0.0026, 95%CI: −0.0039 to −0.0012; p = 0.0003) by IONM (Figs 5, 6 and 7)
Summary
IONM is designed to reduce the incidence of RLN injury, the effect of IONM on RLN injury prevention in thyroid surgery is still controversial[12,13]. Several meta-analyses have been conducted to discuss this topic[12,13,16,17,18]. Most of these studies found that IONM was not superior to visual identification in preventing permanent RLN injury[12,18]. Considering the existing controversial results and new data, we conducted this meta-analysis to clarify the effects of IONM in thyroidectomy. Subgroup analysis was performed to identify the effects of IONM in bilateral operation, malignancy operation, reoperation group and operation volume
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