Intraoperative Neuromonitoring of the Recurrent Laryngeal Nerve is Indispensable During Complete Endoscopic Radical Resection of Thyroid Cancer: A Retrospective Study

Overview

Journal Laryngoscope Investig Otolaryngol

Publisher Wiley

Specialty Otorhinolaryngology

Date 2022 Aug 24

PMID 36000043

Authors

Yang Fei

Yang Li

Feng Chen

Wen Tian

Affiliations

Soon will be listed here.

Abstract

Objective: Complete endoscopic radical resection of thyroid cancer, especially through the areolar approach, can achieve curative and acceptable cosmetic effects in patients with differentiated thyroid carcinoma. However, some inherent characteristics of endoscopic procedures hamper functional protection of the recurrent laryngeal nerve (RLN). Intraoperative neuromonitoring (IONM) is considered the most important accessory to protect the nerves during conventional radical thyroidectomy. This study aimed to evaluate the feasibility and necessity of IONM during complete endoscopic radical resection of thyroid cancer.

Methods: A total of 106 patients with differentiated thyroid carcinoma were enrolled in the study between February 2013 and April 2018. Based on the use of the IONM technique, all patients were divided into the IONM ( = 54) and non-IONM groups ( = 52). Overall, 66 RLNs were involved in the IONM group, and 61 RLNs were involved in the non-IONM group. The time and ratio of RLN identification and the number of transient and permanent RLN injuries between both groups were compared.

Results: Compared to the non-IONM group, the IONM group required less time for RLN identification (3.05 ± 1.58 vs. 9.36 ± 4.82 min, < .01). The ratio of RLN identification in the IONM group was much higher than that in the non-IONM group (100.00% vs. 88.52%, = .01). A significant difference was observed in RLN transient injury between the two groups (one case accounting for 1.51% in the IONM group vs. eight cases accounting for 13.11% in the non-IONM group; = .03).

Conclusion: IONM significantly improved RLN identification and reduced transient RLN injuries during complete endoscopic radical resection.

Level Of Evidence: 3b.

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