Intraoperative Neuromonitoring does not Reduce the Incidence of Recurrent Laryngeal Nerve Palsy in Thyroid Reoperations: Results of a Retrospective Comparative Analysis

Recurrent laryngeal nerve (RLN) palsy is the major concern of reoperative thyroid surgery, and the introduction of neuromonitoring could reduce the rate of this complication. The present study is a retrospective analysis of the experience with completion thyroidectomy with and without neuromonitoring in a referral center. Between October 1999 and April 2011, 246 patients [37 men, 209 women; mean age, 55 +/- A 12.5 (range, 25-80) years] underwent 250 reoperations for recurrent goiter ( = 203), hyperthyroidism ( = 26), or recurrent thyroid cancer ( = 17). The mean interval between the initial and the reoperative procedure was 17.5 years. According to the availability of the neuromonitoring system and to the surgeon preference, 91 operations were performed with neuromonitoring (NM-group), whereas 159 were performed with direct nerve visualization (NV-group) alone. Patients' characteristics, perioperative data, and postoperative complications were collected in a prospectively maintained database. In the NM-group, 51 unilateral and 40 bilateral resections were performed. The NV-group included 122 unilateral and 37 bilateral procedures. The number of nerves at risk after previous surgery was 128 (NM-group) and 161 (NV-group), respectively. We registered eight RLN palsy in the NM-group (6.2 %) and four in the NV-group (2.5 %; = 0.1). The routine use of intraoperative neuromonitoring seems not to reduce the incidence of RLN during redo thyroid surgery, at least in the setting of a tertiary referral center.