• Henning Dralle, Carsten Sekulla, Johannes Haerting, Wolfgang Timmermann, Hans Jürgen Neumann, Eberhard Kruse, Stefan Grond, Hans Peter Mühlig, Christian Richter, Johannes Voss, Oliver Thomusch, Hans Lippert, Ingo Gastinger, Michael Brauckhoff, and Oliver Gimm.
• Department of General, Visceral and Vascular Surgery, Klinikum Kröllwitz, University of Halle, Ernst-Grube-Strasse 40, D-06097 Halle, Germany.
• Surgery. 2004 Dec 1;136(6):1310-22.

BackgroundRecurrent laryngeal nerve monitoring (RLNM) has been suspected to reduce postoperative RLN paralysis (RLNP). However, functional outcome of RLNM in comparison with no nerve identification and visual nerve identification only has not been analyzed.MethodsAnalysis of 16,448 consecutive multi-institutional operations resulted in 29,998 nerves at risk. Three groups of different RLN treatment were compared: group 1, no RLN identification; group 2, visual RLN identification; and group 3, visual RLN identification and electromyographic monitoring. RLNM was performed with a bipolar needle electrode that was placed through the cricothyroid ligament into the vocal muscle.ResultsRisk factors for permanent RLNP were recurrent benign and malignant goiter (odds ratios, [ORs]), 4.7, and 6.7, respectively), primary surgery in thyroid malignancy (OR, 2.0), lobectomy (OR, 1.8), no nerve identification (OR, 1.4), low or medium volume hospital (OR, 1.3), and low volume surgeons (OR, 1.2).ConclusionsBased on these data, visual nerve identification was identified to be the gold standard of RLN treatment in thyroid surgery. RLNM is a promising tool for nerve identification and protection in extended thyroid resection procedures. However, because of the overall low frequency of RLNP, no statistical difference compared with visual nerve identification only was reached in the setting of this study.

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