Effectiveness of Nerve Monitor in Thyroidectomy; A Single Centre Retrospective Analysis
Author(s): Vinod Kumar Singhal, Prashant Sharma, Nufra Senopher, Adil Md Suleman, Md Merajuddin, Rafat Samuel, Vidher V. Singhal, Faris Dawood Al Aswad.
Background: Individuals with hyperthyroidism, goiter, or thyroid cancer frequently undergo a surgical intervention called thyroidectomy, which entails the extraction of the thyroid gland. It is critical to address concerns regarding vocal cord problems caused by injuries to the recurrent laryngeal nerve (RLN). The efficacy of intraoperative neuromonitoring in preventing RLN injury is a topic of debate. However, it allows for realtime assessment of RLN function during surgery.
Aims of the study: The study aims to compare procedures performed with and without intraoperative nerve monitoring.
Methodology: This retrospective cohort study compared patients who received intraoperative nerve monitoring (IONM) at Dubai’s Prime Hospital with those who did not. The study included 482 thyroidectomy operations performed over ten years (2014-2024). All 380 patients in Group A underwent intraoperative neuromonitoring (IONM) as part of their treatment, whereas none of the 100 patients in Group B received it. The study included adults who had undergone thyroid surgeries, were free from specific medical concerns, and could participate independently. Laryngoscopy confirmed the presence of paresis following treatment for recurrent laryngeal nerve (RLN) injury. During the surgical procedure, intraoperative neurophysiological monitoring (IONM) helps identify and locate the recurrent laryngeal nerve (RLN) and verify its intactness achieved using the NIM Eclipse E4 nerve monitoring system, which employs a specific array of electrodes.
Results: We assessed the efficacy of nerve monitoring in thyroidectomy in two patient groups: Group A (N = 380) and Group B (N = 100). Baseline characteristics were similar, with mean ages of 49.65 years in Group A and 47.56 years in Group B. Group A had a slightly higher thyroid gland weight and nodular size. Both groups had a higher percentage of female patients (83.42% and 82%). Total thyroidectomy was the most common procedure. Group A showed a significantly shorter mean identification time for the recurrent laryngeal nerve (RLN) (4.15 vs. 10.85 minutes) and a shorter operation time (66.31 vs. 80.0 minutes). Group A had no unilateral or partial RLN damage, whereas one patient in Group B experienced partial damage (1.0%).
Conclusion: Our study concluded that intraoperative nerve monitoring (IONM) can effectively reduce the duration of thyroidectomy by facilitating the identification of the recurrent laryngeal nerve (RLN). IONM expedited identifying RLNs and shortened surgery times, making the procedure more efficient, especially in high-risk cases, with no noticeable difference in nerve paralysis post-surgery.