Neuromonitoring in endoscopic and robotic thyroidectomy.

Area of Science:

• Surgical Technology
• Neurosurgery
• Endocrinology

Background:

• Intraoperative neuromonitoring (IONM) is established for recurrent laryngeal nerve (RLN) function verification in conventional thyroid surgery.
• A systematic assessment of IONM in newer endoscopic and robotic thyroidectomy techniques was lacking.

Purpose of the Study:

• To systematically review and assess the evidence for intraoperative neuromonitoring (IONM) in endoscopic and robotic thyroidectomy.
• To evaluate the safety and efficacy of IONM in these minimally invasive procedures.

Main Methods:

• Systematic literature review using evidence-based criteria (2000-2015).
• Searched four databases (CENTRAL, MEDLINE, Cochrane, EMBASE) for studies on endoscopic/robotic thyroidectomy and IONM.
• Extracted data on study design, population, intervention, quality, and outcomes.

Main Results:

• Only 9% of 160 retrieved studies utilized IONM in endoscopic or robotic thyroidectomy.
• IONM was used in 522 nerves at risk across eight studies, with only three prospective randomized trials.
• Recurrent laryngeal nerve palsy rates were low: 0-3.6% transient and 0-0.4% permanent.

Conclusions:

• IONM is a valuable assistive technology for navigating complex endoscopic and robotic thyroidectomy procedures.
• IONM demonstrates potential as a routine adjunct for nerve identification, similar to conventional thyroid surgery.
• Further research is needed to establish standardized protocols for IONM in minimally invasive thyroid surgery.