title: Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: experience of 2034 consecutive patients.
abstract: BACKGROUND
  The aim of this study was to evaluate the ability of intraoperative neuromonitoring in reducing the postoperative recurrent laryngeal nerve palsy rate by a comparison between patients submitted to thyroidectomy with intraoperative neuromonitoring and with routine identification alone.
  
  
  METHODS
  Between June 2007 and December 2012, 2034 consecutive patients underwent thyroidectomy by a single surgical team. We compared patients who have had neuromonitoring and patients who have undergone surgery with nerve visualization alone. Patients in which neuromonitoring was not utilized (Group A) were 993, patients in which was utilized (group B) were 1041.
  
  
  RESULTS
  In group A 28 recurrent laryngeal nerve injuries were observed (2.82%), 21 (2.11%) transient and 7 (0.7%) permanent. In group B 23 recurrent laryngeal nerve injuries were observed (2.21%), in 17 cases (1.63%) transient and in 6 (0.58%) permanent. Differences were not statistically significative.
  
  
  CONCLUSIONS
  Visual nerve identification remains the gold standard of recurrent laryngeal nerve management in thyroid surgery. Neuromonitoring helps to identify the nerve, in particular in difficult cases, but it did not decrease nerve injuries compared with visualization alone. Future studies are warranted to evaluate the benefit of intraoperative neuromonitoring in thyroidectomy, especially in conditions in which the recurrent nerve is at high risk of injury.
authors.affiliation: Department of Surgical Sciences, University of Cagliari, Cagliari, Italy. pgcalo@unica.it.
authors.forename: Pietro Giorgio
authors.initials: PG
authors.lastname: Calò
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pisano
authors.forename: Fabio
authors.initials: F
authors.lastname: Medas
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Pittau
authors.forename: Luca
authors.initials: L
authors.lastname: Gordini
authors.forename: Roberto
authors.initials: R
authors.lastname: Demontis
authors.forename: Angelo
authors.initials: A
authors.lastname: Nicolosi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control*; D064795:Intraoperative Neurophysiological Monitoring; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012009:Recurrent Laryngeal Nerve / Q000503:physiopathology*; D061226:Recurrent Laryngeal Nerve Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control*; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy; D055815:Young Adult