Intraoperative Neuromonitoring of the Recurrent Laryngeal Nerve in Robotic Thyroid Surgery

This study evaluated the technical feasibility and efficacy of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) to aid its identification and preservation during robotic thyroidectomy (RoT). IONM of the RLN was evaluated in 30 consecutive patients undergoing RoT. All patients underwent an indirect laryngoscope examination to objectively assess vocal cord function. Their Voice Handicap Index-10 (VHI10) was measured to subjectively assess vocal cord function pre-operatively and at postoperative months 1 and 3. Of the 56 RLNs at risk in 30 patients undergoing RoT, all were visualized and identified by IONM. The IONM sensitivity for postoperative permanent RLN palsy was 100%, with a positive predictive value of 100%. The mean VHI-10 scores pre-operatively and at postoperative months 1 and 3 were 0.20 +/- 0.66, 3.47 +/- 5.04, and 1.53 +/- 2.47, respectively (P<0.001). IONM of the RLN during RoT is technically feasible and effective for identifying this nerve.