Abstract
Objective: Neurostimulation with laryngeal palpation (NSLP) is an intermittent monitoring technique that facilitates nerve identification and permits an assessment of the recurrent laryngeal nerve (RLN) function during thyroid surgery. In this study we report our experience with NSLP, evaluating the predictive value of this technique for postoperative RLN deficit. Method: We analyzed retrospectively a consecutive series of 1584 patients undergoing thyroid surgery from 2002 to 2011 at Sant’Orsola - Malpighi Hospital of Bologna. Sensitivity, specificity, PPV, and NPV were calculated for NSLP, considering an absent laryngeal twitch (LT) at the end of the surgical procedure as predictive for RLN palsy. Results: The incidence of nerve palsy, calculated on a total of 2917 nerves at risk, was 2.1% (64 cases). Sensitivity, specificity, and positive and negative predictive values resulted respectively: 53%, 96.5%, 34.9%, and 98.4%. Conclusion: Our results indicate that NSLP is still a useful and economic tool for RLN monitoring during thyroid surgery. Moreover the high specificity and NPV of NSLP confirm that this technique provides important prognostic information regarding vocal cord function at the end of dissection of the first lobe during total thyroidectomy.
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