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Updated: Aug 9, 2026
Intra-Operative Neural Monitoring of Thyroid Surgery in a Porcine Model
Published on: February 11, 2019
Evaluation of intraoperative recurrent nerve monitoring in thyroid surgery
Guido Beldi1, Thomas Kinsbergen, Rolf Schlumpf
1Department of Surgery, Kantonsspital Aarau, CH-5001 Aarau, Switzerland. g.beldi@gmx.ch
Insights
Intraoperative neuromonitoring aids recurrent laryngeal nerve identification during thyroid surgery but does not lower nerve injury rates. Its ability to confirm nerve integrity is high, but detecting functional loss is unreliable.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Endocrinology
Background:
- Thyroid surgery poses a risk of recurrent laryngeal nerve (RLN) injury.
- Intraoperative neuromonitoring (IONM) was developed to improve RLN identification and protection.
- IONM aims to reduce the incidence of vocal cord paralysis following thyroidectomy.
Purpose of the Study:
- To evaluate the effectiveness of IONM in reducing RLN injuries during thyroid surgery.
- To assess the incidence of permanent and transient RLN palsy in patients undergoing thyroidectomy with IONM.
- To determine the predictive value of IONM for nerve function preservation.
Main Methods:
- A retrospective study of 288 patients undergoing thyroid surgery between February 1996 and June 2002.
- Utilized intraoperative identification and IONM for the RLN in all cases.
- Stratified outcomes based on disease type: benign, malignant, and recurrent thyroid disease.
Main Results:
- Overall permanent RLN palsy rate was 1.4%; transient palsy rate was 8.7%.
- IONM demonstrated a negative predictive value of 99% for nerve integrity.
- Positive predictive value for detecting nerve dysfunction was only 33%.
Conclusions:
- IONM did not significantly lower the incidence of recurrent nerve lesions in benign, malignant, or recurrent thyroid disease.
- While IONM can verify nerve integrity, it is unreliable in detecting functional nerve loss.
- Further advancements are needed to improve the diagnostic accuracy of IONM for RLN function during thyroid surgery.
Abstract:
Surgical exposure of the recurrent laryngeal nerve decreases the incidence of nerve injuries during thyroid surgery. Intraoperative neuromonitoring was introduced to facilitate identification and protection of the recurrent laryngeal nerve. Between February 1996 and June 2002 a total of 288 patients underwent thyroid surgery with intraoperative identification and intraoperative neuromonitoring of the recurrent laryngeal nerve. The overall incidences of permanent and transient recurrent nerve palsy (considered as a percentage of the nerves at risk) were 1.4% and 8.7%, respectively. Results were stratified in benign, malignant, and recurrent thyroid disease. Intraoperative function testing revealed a positive predictive value of 33% and negative predictive value of 99%. We concluded that the incidence of recurrent nerve lesions in benign, malignant, and recurrent thyroid disease was not lowered by the use of intraoperative neuromonitoring. Although an intact nerve can be verified by the neuromonitoring, the loss of nerve function cannot be reliably identified.
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