NEURAL MONITORING IN RLN RECOVERY COURSE IN THYROID SURGERY FOR ANALYZING COST EFFECTIVENESS

Volume : VII, Issue : VI, June - 2018

Dr. Mohammed Zubair, Dr. T. Badrinath

The study group comprised 854 patients (139 men, 715 women) operated for recurrent goiter (n = 576), recurrent hyperthyroidism (n = 36),

completion thyroidectomy for cancer (n = 194) or recurrent thyroid cancer (n = 48), including 472 bilateral and 382 unilateral reoperations; 1,326

nerves at risk (NAR). A group of 306 patients (500 NAR) underwent reoperations with IONM and 548 patients (826 NAR) had reoperations with

RLN visualization, but without IONM. Transient and permanent RLN injuries were found respectively in 13 (2.6 %) and seven (1.4 %) nerves with

IONM versus 52 (6.3 %) and 20 (2.4 %) nerves without IONM (p = 0.003 and p = 0.202, respectively). IONM decreased the incidence of transient

RLN paresis in repeat thyroid operations compared with nerve visualization alone. The prevalence of permanent RLN injury tended to be lower in

thyroid reoperations with IONM, but statistical validation of the observed differences requires a sample size of 920 NAR per arm. The prevalence

of recurrent laryngeal nerve (RLN) injury is higher in repeat than in primary thyroid operations. The use of intraoperative nerve monitoring

(IONM) as an aid in dissection of the scar tissue is believed to minimize the risk of nerve injury. The aim of this study was to examine whether the

use of IONM in thyroid reoperations can reduce the prevalence of RLN injury. This was a retrospective cohort study of patients who underwent

thyroid reoperations with IONM versus with RLN visualization, but without IONM. The database of thyroid surgery was searched for eligible

patients (treated in the years 1993–2012). The primary outcomes were transient and permanent RLN injury. Laryngoscopy was used to evaluate

and follow RLN injury.