Feasibility and Effectiveness of Intraoperative Nerve Monitoring in Total Endoscopic Thyroidectomy for Thyroid Cancer

To demonstrate the feasibility of intraoperative nerve monitoring (IONM) in total endoscopic thyroidectomy (TET) for high-risk thyroid cancer and to confirm its additional benefit on reducing surgery duration and protecting the recurrent laryngeal nerve (RLN).

One hundred twenty-three patients with or without autoimmune thyroiditis (AT) underwent TET using IONM or not were included in the study. The primary outcome measures were the time used on related surgery procedures and the prevalence of RLN injury.

IONM could effectively reduce the time for locating the RLN (9.91 ± 1.68 minutes versus 12.49 ± 1.63 minutes; P < .01) and thyroid lobectomy (21.10 ± 4.53 minutes versus 27.35 ± 5.38 minutes; P < .01) but not central compartment dissection or whole surgery with or without AT. Of 167 at-risk nerves (98 in the IONM group and 69 in the non-IONM group), 5 (5.10%) in the IONM group (2 with and 3 without AT) suffered from temporary injury, compared with 7 (10.14%) in the non-IONM group (4 with and 3 without AT). Only 1 in the IONM group (with AT) and 2 in the non-IONM group (1 with and 1 without AT) developed permanent vocal cord paresis. The prevalence of RLN paresis was slightly decreased in the IONM group without statistical significance.

IONM could reduce the time needed for RLN localization and thyroid lobectomy and make it easier for novices in TET. IONM also may decrease the incidence of the RLN paresis, especially temporary, compared with visualization alone; this proposal needs more evidence to confirm it in the future.