Association of Intraoperative Neuromonitoring With Reduced Recurrent Laryngeal Nerve Injury in Patients Undergoing Total Thyroidectomy

摘要: Importance Injury of the recurrent laryngeal nerve (RLN) is one most serious complications thyroid surgery. Intraoperative neuromonitoring (IONM) has been introduced to verify RLN function integrity and may be a helpful adjunct in dissection. Objective To determine whether use IONM can reduce incidence injury patients undergoing total thyroidectomy. Design, Setting, Participants This cohort study included 2556 who underwent thyroidectomy between January 2002 December 2012 Department Otolaryngology–Head Neck Surgery Venizeleio General Hospital, Heraklion, Greece. Patients had during procedure (n = 1481) were compared with surgery visualization alone (n = 1075). All indirect laryngoscopy–fiberoptic nasopharyngoscopy both preoperatively on day 2 after assess vocal cord motility. Main Outcomes Measures Use injury. Results A (2028 women 528 men [5112 RLNs at risk]; mean [SD] age, 51.35 [14.18] years; age range, 18-89 years) Univariate analysis showed that resulted significant reduction (3.3% vs 0.7%) relative risk 2.6% (odds ratio [OR], 5.15; 95% CI, 3.12-8.49; number needed treat, 19). Multivariate logistic regression no was an independent factor for (adjusted OR [AOR], 5.44; 3.26-9.09). Additional factors operative time (AOR, 12.91; 6.66-25.06), maximum diameter greater than 45 mm right lobe 4.91; 3.12-8.56) left 2.24; 1.39-4.32), extrathyroid extension 3.26; 1.62-6.59), incidental parathyroidectomy 3.30; 2.13-5.09), tumor size larger 10 3.24; 1.59-6.62). Conclusions Relevance Our findings decreased significantly temporary permanent injuries. The technology safe reliable, this technique important dissection functional neural integrity. routine reduced pitfalls provided guidance our surgeons difficult cases, reoperations, high-risk patients.