title: Role of intraoperative neuromonitoring of recurrent laryngeal nerves in the outcomes of surgery for thyroid cancer.
abstract: BACKGROUND
  The aim of this retrospective study was to evaluate the ability of intraoperative neuromonitoring to predict the postoperative functional outcome and its role in reducing the postoperative recurrent laryngeal nerve palsy rate during thyroidectomy for thyroid malignancy.
  
  
  METHODS
  Between June 2007 and March 2013, 656 consecutive patients with thyroid cancer underwent thyroidectomy by a single surgical team. We compared 357 patients who have had neuromonitoring (Group A) to 299 patients who have undergone surgery with nerve visualization alone (group B).
  
  
  RESULTS
  In group A 7 recurrent laryngeal nerve paralysis were observed (1.96%), 6 (1.68%) transient and 1 (0.28%) permanent; a bilateral recurrent laryngeal palsy was observed in 1 of the 7 cases (0.28%). In group B 6 recurrent laryngeal nerve paralysis were observed (2.01%), 5 (2.01%) transient and 1 permanent (0.33%); bilateral palsy was observed in 1 of the 6 cases (0.33%). Differences were not statistically significative.
  
  
  CONCLUSIONS
  Routine visual nerve identification remains the gold standard of recurrent laryngeal nerve management in surgery for thyroid cancer. Intraoperative neuromonitoring is safe, effective, reliable, and easy to perform in excluding postoperative recurrent laryngeal palsy. It helps to identify the nerve in thyroid cancer, but it did not decrease the injuries compared with visualization alone in this study; however, its use can change the operative strategy in order to prevent the risk of bilateral damage in case of signal loss. Future studies are needed to evaluate the benefit of intraoperative neuromonitoring in thyroidectomy for thyroid cancer.
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042 Monserrato, Cagliari, Italy. Electronic address: pgcalo@unica.it.
authors.forename: Pietro Giorgio
authors.initials: PG
authors.lastname: Calò
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042 Monserrato, Cagliari, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Medas
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042 Monserrato, Cagliari, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Erdas
authors.affiliation: School of Specialty in Forensic Medicine, University of Cagliari, S.S. 554, Bivio Sestu, 09042 Monserrato, Cagliari, Italy.
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Pittau
authors.affiliation: Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, S.S. 554, Bivio Sestu, 09042 Monserrato, Cagliari, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Demontis
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042 Monserrato, Cagliari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pisano
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042 Monserrato, Cagliari, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Nicolosi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012009:Recurrent Laryngeal Nerve / Q000503:physiopathology*; D061226:Recurrent Laryngeal Nerve Injuries / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
keywords: Neuromonitoring; Recurrent laryngeal nerve; Thyroid cancer