Double probe intraoperative neuromonitoring with a standardized method in thyroid surgery

Area of Science:

• Endocrine Surgery
• Neurosurgery
• Surgical Innovation

Background:

• Thyroid surgery carries risks of recurrent laryngeal nerve (RLN) injury, potentially causing voice impairment.
• Intraoperative neuromonitoring (IONM) aims to mitigate these risks by monitoring nerve function during surgery.

Purpose of the Study:

• To evaluate the effectiveness of a standardized intraoperative neuromonitoring (IONM) approach for the recurrent laryngeal nerve (RLN) and vagus nerve (VN) in thyroid surgery.
• To compare surgical outcomes between a group using IONM and a control group.

Main Methods:

• Retrospective study comparing 300 total thyroidectomies with IONM (experimental group) against 300 without (control group).
• Pre- and post-operative videolaryngoscopy assessed RLN identification and injury rates (transient and permanent).
• IONM performance metrics (Sensitivity, Specificity, Predictive Values, Accuracy) were calculated for the experimental group.

Main Results:

• IONM significantly improved RLN identification rates (99.1% vs. 92%, P<0.0001).
• Transient RLN injuries were significantly reduced in the IONM group (0.33% vs. 2.67%, P=0.044).
• Permanent RLN injury rates were similar between groups (1.33% vs. 1.67%, P=1).

Conclusions:

• Standardized IONM in thyroid surgery enhances RLN identification.
• IONM use is associated with a reduced incidence of transient RLN injuries.
• This technique improves surgical safety and nerve preservation during thyroidectomy.