Role of Intraoperative Neuromonitoring of the Recurrent Laryngeal Nerve in High-Risk Thyroid Surgery

Background: Thyroid surgeries associated with an elevated incidence of recurrent laryngeal nerve (RLN) injury are considered high-risk thyroidectomies. These high-risk operations include surgery for thyroid cancer, Graves disease, and recurrent goitre. In addition, the size of the goitre is an important risk factor for RLN injury. Objective: In our retrospective study, we tried to evaluate the role of intraoperative neuromonitoring of RLN specifically in high-risk thyroid surgery with 421 nerves at risk. Method: Thyroid surgeries in our study were done by experienced surgeons in a high-volume provider centre. The overall percentage of RLN injury was 8.8% in the monitored group in comparison with 9.1% in the unmonitored group. The percentage of permanent nerve palsy in the monitored group was 3.9% of nerves at risk in comparison with 3.8% in the unmonitored group. No statistically significant difference was found between groups. Conclusion: Routine visual identification of the nerve by meticulous dissection is the best method to avoid RLN injury. The benefit of RLN neuromonitoring could be further assessed by performing a multicentre prospective study to compare the role of RLN neuromonitoring in high-risk thyroid surgeries.