Incidence of Vocal Cord Paralysis With and Without Recurrent Laryngeal Nerve Monitoring During Thyroidectomy

Abstract

To compare the incidence of postoperative vocal cord paresis or paralysis in a cohort of patients who underwent thyroidectomy with and without continuous recurrent laryngeal nerve (RLN) monitoring by a single senior surgeon. We hypothesize that continuous RLN monitoring reduces the rate of nerve injury during thyroidectomy Design: Retrospective medical chart review.Setting: Academic tertiary care medical center.Patients: A total of 684 patients (1043 nerves at risk) who underwent thyroid surgery under general anesthesia.Main Outcome Measure: Incidence of vocal cord paresis or paralysis in patients who underwent thyroid surgery with continuous RLN monitoring vs those undergoing surgery without continuous RLN monitoring. Results:The incidence of unexpected unilateral vocal cord paresis based on RLNs at risk was 2.09% (n=14) in the monitored group and 2.96% (n=11) in the unmonitored group. This difference was not statistically significant. The incidence of unexpected complete unilateral vocal cord paralysis was 1.6% in each group. Two of the 5 paralyses in the unmonitored group and 7 of the 11 paralyses in the monitored group had complete resolution.Conclusions: Monitoring of the RLN does not appear to reduce the incidence of postoperative temporary or permanent complete vocal cord paralysis. There appeared to be a slightly lower rate of postoperative paresis with RLN monitoring, but this difference was not statistically significant.

Recurrent laryngeal nerve injury in thyroid surgery: a review

“…Several studies show a small reduction in RLNP incidence using IONM, but fail to exhibit statistical significance when compared with direct visualization alone. 6,12,13,17,[49][50][51][52][53][54] The one published randomized control trial comparing IONM versus identification alone in bilateral thyroid surgery concluded that IONM reduced rates of transient but not permanent palsies. 55 The recent meta-analysis by Higgins et al analysed 56 There are some instances where evidence for IONM use is stronger, suggesting that it can aid in the identification of the nerve, correlating with decreased complication rates.…”

Tiroid Cerrahisi Deneyimlerimiz

“…Kalıcı hipokalsemi ise daha nadirdir ve yaklaşık %0,4-13,8 oranında bildirilmiştir (5). Hipokalsemi riski tümör boyutuna, invazyon derecesine, patolojisine, cerrahinin genişliğine ve cerrahın deneyimine bağlıdır (6).…”

Experiencia clínica en tiroidectomía total

“…La frecuencia esperada de hipocalcemia posoperatoria es hasta 40%. La gran mayoría de las hipocalcemias 7%, con lesiones permanentes idealmente no mayores al 1% 1,17,18 . El monitoreo del nervio recurrente no ha demostrado disminuir la frecuencia de esta complicación 17 .…”

“…La gran mayoría de las hipocalcemias 7%, con lesiones permanentes idealmente no mayores al 1% 1,17,18 . El monitoreo del nervio recurrente no ha demostrado disminuir la frecuencia de esta complicación 17 . En nuestra serie registramos un caso (2,9%) de hipocalcemia permanente y ningún caso de lesión NLR permanente.…”