Is the use of intraoperative nerve monitoring an effective method to reduce the rate of permanent recurrent laryngeal nerve paralysis?

摘要

Aim: Recurrent laryngeal nerve (RLN) paralysis is a common complication of thyroid surgery. In recent years, intraoperative nerve monitoring (IONM) has been used to reduce the risk of RLN paralysis. The purpose of this study was to assess the role of IONM in reducing RLN paralysis.Methods: A retrospective clinical study was conducted between January 2015 and January 2017 in a two-center-clinical trial at Lutfiye Nuri Burat State and Haseki Teaching and Research Hospitals. Patients who underwent thyroidectomy using IONM (Group A, n=100) or direct visual technique (Group B, n=232) were included. Patients' files were reviewed for age, body mass index, gender, American Society of Anesthesiologists score, calcium levels, complications, duration of operation and follow-up. Postoperative complications were regarded as the main outcomes.Results: A total of 332 patients (52 male, 280 female) with a mean age of 46.4±12.9 years were enrolled. 30.1% of the patients were in Group A (IONM). Bilateral and unilateral thyroidectomies were performed in 70.8% and 29.2% of the operations, respectively. Operative time was shorter in Group A (76.9±12.0 minutes vs 97.7±27.6 minutes, p <0.001). There was no significant difference between the two groups in terms of preoperative and postoperative calcium levels (p=0.407).There was no statistically significant difference in early RLN paralysis rates between the two groups (for Group A and Group B, 10 (10%) and 34 (14%), respectively) (p=0.251) While it was not present in Group A, permanent RLN paralysis was found in 10 patients in Group B (4.3%) (p = 0.035).Conclusion: The use of IONM may be useful in reducing the rate of permanent RLN paralysis.