Safe Thyroid Surgery


Recurrent laryngeal nerve (RLN) injury is the most severe complication of thyroid surgery, leading to transient or permanent voice changes if one nerve is damaged and breathing difficulty if both the nerves are damaged. Intraoperative nerve monitoring (IONM) was designed to prevent RLN injury.Particularly, we recommend routine IONM for use in total thyroid removal and malignancy(cancer) operations.According to reported data, the incidence of transient RLN injury and permanent RLN injury in thyroidectomy are 2–11% and 0.6–1.6%, respectively.

Routine visual identification of RLN is applied in thyroid surgery to prevent RLN injury, which serves as a conventional measure to reduce vocal cord paralysis. Dionigi et al. found that the causes of RLN injury included transection, clamping, ligatures, suction,traction, thermal injuries and physical compression.Meta-analysis-Binglong Bai et al indicated that IONM could reduce the incidence of total, transient and permanent RLN injury compared with conventional visual identification.