Related Experiment Video
Updated: Apr 29, 2026
Intra-Operative Neural Monitoring of Thyroid Surgery in a Porcine Model
Published on: February 11, 2019
Selective visualization of the recurrent laryngeal nerve during parathyroidectomy
Marina E Robson Chase1, Mackenzie Donoho1, Oliver J Fackelmayer1
1University of Kentucky, Department of General, Endocrine, and Metabolic Surgery, 800 Rose Street, MN268A, Lexington, KY, 40508, USA.
Introduction:
Direct visualization of the recurrent laryngeal nerve (RLN) is considered the gold standard for avoiding nerve injury during parathyroidectomy. We hypothesize that with routine intraoperative nerve monitoring (IONM), RLN visualization is not mandatory for safe parathyroidectomy.
Methods:
Following institutional review board approval, adult patients undergoing parathyroidectomy using IONM during a two-year period were reviewed. The RLN was only visualized if exposed during parathyroid gland dissection. Outcomes included the rate of nerve visualization and rates of RLN injury.
Results:
240 of 479 (50.1 %) nerves at risk were visualized. There was loss of signal in three cases where the RLN was visually identified and none in non-visualized cases. The rates of temporary and permanent RLN injury were 0.99 % and 0 %, respectively.
Conclusion:
Routine IONM provides reassurance of nerve integrity in cases where the RLN is not visualized and an acceptably low rate of RLN injury is achieved with selective visualization.
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