Recurrent laryngeal nerve monitoring versus identification alone on post‐thyroidectomy true vocal fold palsy: A meta‐analysis

Higgins, Thomas S.; Gupta, Reena; Ketcham, Amy S.; Sataloff, Robert T.; Wadsworth, J. Trad; Sinacori, John T.

doi:10.1002/lary.21578

Cited by 229 publications

(197 citation statements)

References 38 publications

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“…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. 12,49,55,57 The large International Intraoperative Monitoring Study Group strongly advocate the use of IONM, applying its use to aid in the initial identification, dissection and prognostication of post-operative function.…”

Section: The Role Of Ionmmentioning

confidence: 99%

Recurrent laryngeal nerve injury in thyroid surgery: a review

Hayward

Grodski

Yeung

et al. 2012

ANZ Journal of Surgery

205

129

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Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. Permanent RLNP occurs in 0.3-3% of cases, with transient palsies in 5-8%. A literature review and analysis of recent data regarding RLNP in thyroid surgery was performed, with particular focus on the identification of high-risk patients, the role of intraoperative identification and dissection of the nerve, and the role of intraoperative neuromonitoring (IONM) and optimal perioperative nerve assessment. In conjunction with the review, data from the Monash University/ Alfred Hospital Endocrine Surgery Unit between January 2007 and October 2011 were retrospectively analysed, including 3736 consecutive nerves at risk (NAR). The current literature and our data confirm that patients undergoing re-operative thyroid surgery and thyroid surgery for malignancies are at increased risk of RLNP. Intraoperative visualization and capsular dissection of the RLN remain the gold standard for intraoperative care during thyroid surgery for reducing RLNP risk. IONM should not be used as the sole mechanism for identifying and preserving the nerve, although it can be used to aid in the identification and dissection of the nerve, and may aid in nerve protection in high-risk cases including cancer surgery and re-operative surgery.

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Section: The Role Of Ionmmentioning

confidence: 99%

Recurrent laryngeal nerve injury in thyroid surgery: a review

Hayward

Grodski

Yeung

et al. 2012

ANZ Journal of Surgery

205

129

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“…This is not the case in the dreaded bilateral RLNP [3,4]. There continues to be a debate regarding intermittent intraoperative neuromonitoring of the RLN (I-IONM), as in recent literature on the systematic use of I-IONM there was no reduction in RLNP rates [5] and the number of patients needed to be treated to avoid a RLN is relatively high [2]. A recent meta-analysis and a randomized study Paper show benefit in reducing transient RLNP in complex cases [6,7].…”

Section: Introductionmentioning

confidence: 99%

Modification of the Surgical Strategy for the Dissection of the Recurrent Laryngeal Nerve Using Continuous Intraoperative Nerve Monitoring

et al. 2017

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Background The aim of this study was to describe first experiences and changes in management using continuous intraoperative neuromonitoring (C-IONM) in thyroid and parathyroid surgery. Method Retrospective analysis of patients who underwent surgery with C-IONM since 2012. Surgical maneuvers were modified when electrophysiologic events occurred. Patients with persistent loss of signal (LOS) underwent postoperative laryngoscopy. Results One hundred and one patients (of 1586 neck surgeries) were included and 19 had events: In 13 these were temporary (resolved before end of surgery) and led to intraoperative modifications in surgical approach; in all cases traction was released, and in 8, recurrent laryngeal nerve (RLN) approach was changed [superior approach (2), inferior approach (2), both (4)]. Six patients had persistent LOS (5.9%, present at end of procedure), with RLN palsy (RLNP) on postoperative day 1: In three, LOS occurred at electrode placement on the vagus nerve, leading to distal placement of the electrode allowing ipsilateral dissection under continuous monitoring; all three had complete recovery at 6 months. In the three other patients, LOS occurred on the RLN: one probable thermal, one traction lesion and one accidental section of the anterior RLN branch. The RLN recovered within 6 months in two patients, and in the third, RLNP persisted after 6 months (1/101 = 1%). Conclusion C-IONM provides real-time evaluation of the RLN function, allowing for adaptation of surgical maneuvers to prevent RLNP. It seems particularly useful in difficult cases like redo neck surgery, invasive thyroid cancer and intrathoracic or large goiter. Care should be given at electrode placement on the vagus nerve.

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“…Probability of cost-effectiveness included observational and experimental studies (5) and another that only included randomized controlled trials (6), did not find a significant difference in RLN injury frequency when comparing neuromonitoring with the standard procedure. However, some authors still recommend the use of neuromonitoring, and the costs of implementation are unknown (17,18).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, neuromonitoring has been recommended as a novel alternative to further decrease the rate of RLN palsy (4). Two published meta-analyses did not demonstrate a statistically significant difference in the rate of RLN injury (5,6). Nonetheless, some authors suggest that its use can be cost-effective based on the decrease of sequels (7), but this argument has not been tested in the literature or the Colombian health system.…”

mentioning

confidence: 99%

Análisis económico de la neuromonitoría rutinaria del nervio laríngeo recurrente en tiroidectomía total

Sanábria

Ramírez

2015

biomedica

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Introduction: Thyroidectomy is a common surgery. Routine searching of the recurrent laryngeal nerve is the most important strategy to avoid palsy. Neuromonitoring has been recommended to decrease recurrent laryngeal nerve palsy. Objective: To assess if neuromonitoring of recurrent laryngeal nerve during thyroidectomy is costeffective in a developing country. Materials and methods:We designed a decision analysis to assess the cost-effectiveness of recurrent laryngeal nerve neuromonitoring. For probabilities, we used data from a meta-analysis. Utility was measured using preference values. We considered direct costs. We conducted a deterministic and a probabilistic analysis. Results: We did not find differences in utility between arms. The frequency of recurrent laryngeal nerve injury was 1% in the neuromonitor group and 1.6% for the standard group. Thyroidectomy without monitoring was the less expensive alternative. The incremental cost-effectiveness ratio was COP$ 9,112,065. Conclusion: Routine neuromonitoring in total thyroidectomy with low risk of recurrent laryngeal nerve injury is neither cost-useful nor cost-effective in the Colombian health system.

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Recurrent laryngeal nerve monitoring versus identification alone on post‐thyroidectomy true vocal fold palsy: A meta‐analysis

Abstract: This meta-analysis demonstrates no statistically significant difference in the rate of true vocal fold palsy after using intraoperative neuromonitoring versus recurrent laryngeal nerve identification alone during thyroidectomy.

Cited by 229 publications

References 38 publications

Recurrent laryngeal nerve injury in thyroid surgery: a review

Recurrent laryngeal nerve injury in thyroid surgery: a review

Modification of the Surgical Strategy for the Dissection of the Recurrent Laryngeal Nerve Using Continuous Intraoperative Nerve Monitoring

Análisis económico de la neuromonitoría rutinaria del nervio laríngeo recurrente en tiroidectomía total

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