Invited Commentary: Intraoperative Neural Monitoring for Early Vocal Cord Function Assessment After Thyroid Surgery—A Systematic Review and Meta-Analysis

Objectives: This study aimed to analyze the effects of intraoperative neuromonitoring (IONM) on the prevalence of vocal cord palsy (VCP) in thyroid surgery. Methods: Data from 493 patients (839 nerves at risk [NAR]) who underwent thyroid surgery between July 2014 and May 2016 were retrospectively evaluated. The patients were divided into 2 groups: Group 1 (G1) consisted of patients who underwent surgery without IONM, whereas group 2 (G2) consisted of patients who underwent surgery with IONM. The surgical techniques were identical, and experienced surgeons performed the procedures in both groups. Intraoperative neuromonitoring was performed in compliance with the International Neural Monitoring Guidelines. Results: In total, 211 patients (170 female, 41 male) with 360 NAR were included in G1, and 282 patients (220 female, 62 male) with 479 NAR were included in G2. The number of VCP per NAR in G1 and G2 was 33 (9.2%) and 27 (5.6%), respectively ( P = .005). The number of transient VCP per NAR in G1 and G2 was 27 (7.5%) and 23 (4.8%; P = .230), respectively. The number of permanent VCP per NAR in G1 and G2 was 6 (1.7%) and 4 (0.8%; P = .341), respectively. Bilateral VCP was detected in 4 (2.7%) patients in G1, whereas there was no patient with bilateral VCP in G2 ( P = .033). Conclusions: Intraoperative neuromonitoring may decrease the incidence of total VCP and prevent the development of bilateral VCP, which has unfavorable results for both patients and health-care professionals.

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The role of intra-operative nerve monitoring in reducing the risk of recurrent laryngeal nerve injury during thyroid surgery: A systematic review and meta-analysis

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2014.07.026 ◽

2014 ◽

Vol 40 ◽

pp. S8-S9

Author(s):

R. Antakia ◽

N. Antakia ◽

B. McWilliams

Keyword(s):

Systematic Review ◽

Recurrent Laryngeal Nerve ◽

Nerve Injury ◽

Thyroid Surgery ◽

Meta Analysis ◽

Recurrent Laryngeal Nerve Injury ◽

Laryngeal Nerve ◽

Nerve Monitoring ◽

Laryngeal Nerve Injury

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Comparison between Magnification Techniques and Direct Vision in Thyroid Surgery: A Systematic Review and Meta-Analysis

Medicina ◽

10.3390/medicina55110725 ◽

2019 ◽

Vol 55 (11) ◽

pp. 725 ◽

Cited By ~ 3

Author(s):

Sapalidis ◽

Papanastasiou ◽

Fyntanidou ◽

Aidoni ◽

Michalopoulos ◽

...

Keyword(s):

Systematic Review ◽

Thyroid Surgery ◽

Meta Analysis ◽

Parathyroid Glands ◽

Direct Vision ◽

Cochrane Library ◽

Surgical Microscope ◽

Randomized Controlled ◽

Permanent Hypocalcemia ◽

October 17

Background and Objectives: The most common complications after conventional thyroid surgery in adult patients are recurrent laryngeal nerve (RLN) injury and hypocalcemia. Magnification techniques (surgical loupes or surgical microscope) are used for identification of RLN and parathyroid glands to diminish these complications although more evidence is necessary to assess their safety and efficacy in comparison with direct vision. Methods and Materials: Electronic databases (Pubmed, Cochrane Library, Scopus) as well as gray literature sources were searched for randomized controlled trials (RCTs) comparing the frequency of transient/permanent RLN injury and hypocalcemia after thyroid surgery by using magnification techniques and direct vision for identification of RLN and parathyroid glands until October 17, 2019. The main outcomes were transient/permanent RLN injury and hypocalcemia. For all outcomes, 95% confidence intervals (95% CI) were used. Statistical analysis was performed with RevMan 5.3. Results: Systematic review and meta-analysis included 3 RCTs with 437 patients overall. Magnification techniques did not significantly affect the risk of occurrence of transient RLN injury (OR = 0.38, 95% CI (0.11–1.35), I2 = 0%) and transient hypocalcemia (OR = 0.31, 95% CI (0.09–1.09), I2 = 23%) compared with direct vision. Included RCTs demonstrated only two patients with permanent hypocalcemia and another one with permanent RLN injury, who belonged to the direct vision group. Conclusion: The use of magnification techniques for identification of RLN and parathyroid glands seems to be as safe as direct vision. However, they do not decrease the risk of RLN injury and transient hypocalcemia after thyroid surgery compared with direct vision. Finally, further prospective research should be conducted as the sample among the studies was small.

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