Preventing recurrent laryngeal nerve injury in thyroidectomy: the role of continuous vagal monitoring

• 발행기관: 대한신경모니터링학회
• 저자명: Padalhin Andrew
• 간행물 정보: 『Journal of Neuromonitoring & Neurophysiology』Vol.5 No.2, 175~183쪽, 전체 9쪽
• 주제분류: 의약학 > 일반외과학
• 파일형태: PDF
• 발행일자: 2025.11.30

국문 초록

Recurrent laryngeal nerve (RLN) injury remain the most serious complication of thyroidectomy, particularly in high-risk cases involving reoperations, malignancy, or complex anatomy. Continuous intraoperative neuromonitoring (C-IONM) offers real-time nerve stimulation and electromographic feedback, enabling early detection of nerve stress and prevention of irreversible damage. This systematic review evaluates the efficacy, predictive accuracy, and clinical impact of C-IONM in reducing RLN injury during high-risk thyroid surgery. While bread population studies show limited benefit over visual identification or intermittent monitoring, targeted analyses reveal that C-IONM significantly lowers the incidence of permanent RLN injury in complex procedures. Its high negative predictive value supports safe surgical staging to prevent bilateral vocal cord palsy, transforming intraoperative strategy and elevating standards of care. Despite technical challenges and modest setup time, C-IONM demonstrates a favorable safety profile and cost-effectiveness when applied to high-risk cohorts. Adherence to standardized protocols from the International Neural Monitoring Study Group is essential for optimal outcomes. C-IONM should be considered a necessary adjunct in high-risk thyroidectomy, with future randomized trials needed to further quantify its impact.

목차

Introduction

Comparative Efficacy of Continuous Intraoperative Neuromonitoring

Electrophysiological Principles and Predictive Value

Impact on Intraoperative Strategy and Bilateral Palsy Prevention

Technical Implementation, Safety Profile and Economic Considerations

Conclusion and Future Directions

Funding

Conflict of Interest

Data Availability

Author Contributions

ORCID

References

키워드

Laryngeal nerve injuries Thyroidectomy Intraoperative neurophysiological monitoring Vagus nerve Vagus nerve stimulation