Mirallié E, et al. - The potential protective effect of intraoperative neuromonitoring on recurrent laryngeal nerve during total thyroidectomy was investigated. In this study, intraoperative neuromonitoring seemed not decreasing postoperative recurrent laryngeal nerve palsy rate. However, intraoperative neuromonitoring was helpful in predicting normal vocal cord mobility due to its high specificity.

Methods

• Researchers performed a prospective, multicenter French national study.
• As per surgeons' choice, intraoperative neuromonitoring was performed.
• Postoperatively, at day 1 to 2 after operation and at 6 months, they performed laryngoscopy systematically in case of postoperative recurrent laryngeal nerve palsy.
• To compare recurrent laryngeal nerve palsy rates between patients operated with or without intraoperative neuromonitoring, they performed univariate and multivariate analyses and propensity score (sensitivity analysis).

Results

• This study included 1,328 patients (females 79.9%, median age 51.2 years, median body mass index 25.6 kg/m²).
• Out of them, 807 (60.8%) underwent intraoperative neuromonitoring.
• Researchers observed postoperative abnormal vocal cord mobility in 131 patients (9.92%), including 69 (8.6%) and 62 (12.1%) in the intraoperative neuromonitoring and nonintraoperative neuromonitoring groups, respectively.
• Univariate analysis suggested that intraoperative neuromonitoring was associated with a lesser rate of recurrent laryngeal nerve palsy (odds ratio = 0.68, 95% confidence interval, 0.47; 0.98, P=.04).
• However, this was not observed in multivariate analysis (oddsratio = 0.74, 95% confidence interval, 0.47; 1.17, P=.19), or when using a propensity score (odds ratio = 0.76, 95% confidence interval, 0.53; 1.07, P=.11).
• No difference was observed in the rates of definitive recurrent laryngeal nerve palsy (0.8% and 1.3% in intraoperative neuromonitoring and non-intraoperative neuromonitoring groups respectively, P=.39).
• For detecting abnormal postoperative vocal cord mobility, the sensitivity, specificity, and positive and negative predictive values of intraoperative neuromonitoring were 29%, 98%, 61%, and 94%, respectively.