Continuous intraoperative nerve monitoring in thyroidectomies: A meta-analysis

  • Purpose
    Intermittent intra-operative nerve monitoring (I-IONM) in thyroidectomies is standard practice in Australia. In the last decade, the introduction of continuous intraoperative recurrent laryngeal nerve (RLN) monitoring (CIONM) has enabled the operator to verify the functional integrity of the VN-RLN axis in real-time. We aim to present the current evidence on CIONM for thyroid surgery by conducting the first meta-analysis on this technique.  

    Method
    A systematic review of literature was conducted by two independent reviewers via Ovid in the Medline, EMBASE and Cochrane reviews databases. The search was limited to human subject research in peer-reviewed articles published between 1946 and October 2018. Medical subject headings (MeSH) terms utilised were thyroid surgery, thyroidectomies, recurrent laryngeal nerve, vagal nerve, monitor and stimulation. Thirty-eight papers were identified from Ovid, another six papers were identified by hand-search. A random effect meta-analysis was performed with assessment of heterogeneity using the I2 value.

    Results
    A total of 11 papers were included for data extraction. The proportion of post-operative temporary and permanent RLN palsy was 3.97% (95% CI 1.68% – 6.25%, I2=56.67). However, the majority of the RLN palsies recovered in the follow up period; permanent RLN palsy occurred in 1.35% (95% CI 0.495% – 2.20%). There was no report of bilateral RLN palsy. CIONM was not directly associated with any complications.

    Conclusion
    CIONM is a safe and effective means by which RLN palsies in thyroid surgery can be reduced.

 

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