The effect of intraoperative neuromonitoring on damage to the laryngeal nerves in patients undergoing total thyroidectomy

Aim of the research
Assessment of intraoperative neuromonitoring in the prevention of damage to the recurrent laryngeal nerve during total thyroidectomy.

Material and methods
A group of 367 patients qualified for the study, including 312 (85.01%) women and 55 (14.99%) men, aged 18–79 years, having undergone total thyroidectomy due to a neutral nodular goitre. The patients were operated on by one surgeon. The study group consisted of 205 patients, including 173 (84.39%) women and 32 (15.61%) men, aged 19–79 years, who were operated on with the use of intraoperative neuromonitoring. The control group consisted of 162 patients, including 139 (85.80%) women and 23 (14.20%) men, aged 18–77 years, who had undergone surgery only with macroscopic visualisation of the recurrent laryngeal nerve without the application of intraoperative neuromonitoring. Then, in the period from 2 to 10 years after the surgery, follow-up examinations were performed, which included 153 patients from the control group (74.6% [153/205]) and 122 patients from the study group (75.3% [122/162]).

Results
The frequency of vocal fold palsy did not differ statistically significantly in the study group and the control group (study group: 4.9% [10/205], control group: 4.9% [8/162]; p = 0.979). In the follow-up study, the incidence of laryngeal fold palsy did not show statistically significant differences between the study and control groups. Most of the damage to the recurrent laryngeal nerves was persistent.

Conclusions
Neuromonitoring did not reduce the number of recurrent laryngeal nerve injuries in relation to the nerve visualisation alone in noncapsular total thyroidectomy for benign nodular goitre, performed by the same experienced surgeon.