Authors
Vetshev P.S., Yankin P.L., Zhivotov V.A., Poddubny E.I., Prokhorov V.D.
National Medical and Surgical Center named after N.I. Pirogov, Moscow.
Abstract
Patients were divided into two study groups: the first one included 434 patients (764 RLNs at risk), in whom RLN was identified only by visual control; the second one was presented by 402 patients (728 RLNs at risk), in whom RLN was identified by IONM in intermitted regime. The groups of study were analyzed by the following parameters: frequency of transient paresis and palsies of the vocal fold (VF); the duration of restoration of voice quality (VQ); the incidence of persistent dysphonia in the postoperative period and the duration of surgery. All surgical interventions were performed in the NMSC named after N.I. Pirogov from January 2016 to April 2017 by surgeons of the specialized department of endocrine surgery. The collection of the results of operations was completed in April 2018. The frequency of unilateral transient paresis of the VF in group with IONM in comparison with group with only visual identification of RLN was 3.85% and 4.20%, respectively (p = 0.879); the incidence of unilateral palsy of the VF was 0.82% and 0.79%, respectively (p = 0.900). There were no statistically significant differences in clinical outcomes depending on the diagnosis, the extent of surgery and the surgeon experience.
Despite the possibility of 100% identification of RLN with IONM during the operation, we did not find statistically significant benefits of using IONM for reducing the frequency of transient paresis and palsies of the VF, reducing the recovery period of VQ and reducing the frequency of persistent dysphonia, compared with the operations without an IONM.
Keywords: recurrent laryngeal nerve, vocal fold paresis, intraoperative neuromonitoring, IONM, thyroid surgery, parathyroid gland surgery, voice quality, recurrent laryngeal nerve injury.
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