Prevention of recurrent laryngeal nerve injury in thyroid surgery: a systematic review and meta-analysis

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OBJECTIVE

To evaluate the effectiveness of modern methods for preventing damage to recurrent laryngeal nerve in thyroid surgery.

MATERIAL AND METHODS

Full-text prospective comparative studies were reviewed in the PubMed Central databases, bibliographic database of the Russian Science Citation Index and Cochrane library database. Heterogeneity was assessed using forest plots, tau² and I² statistics.

RESULTS

Meta-analysis of pooled risk of recurrent laryngeal nerve injuries revealed significantly lower pooled estimate of the incidence of recurrent laryngeal nerve injuries in groups of intraoperative neuromonitoring (z=–2.04, p=0.0409). Heterogeneity among studies was not significant (I²=28%, p=0.25). Meta-analysis of pooled risk of damage to recurrent laryngeal nerve in case of prevention by precise dissection using ultrasound and electric cauterization found no significant differences in both groups (z= –0.19, p=0.8806). Heterogeneity among studies was moderate (I²=60%, p=0.11). There were no significant publication biases.

CONCLUSION

Intraoperative neuromonitoring and precise dissection of recurrent laryngeal nerve using ultrasound and electric cauterization reduce surgery time. Intraoperative neuromonitoring is advisable as an optional procedure for prevention of damage to recurrent laryngeal nerve.

Keywords:

recurrent laryngeal nerve injury

meta-analysis

thyroid gland

Authors:

Tseimakh A.E.

Altai State Medical University

ORCID: 0000-0002-1199-3699

Shoikhet Ya.N.

Altai State Medical University

ORCID: 0000-0002-5253-4325

Pantyushin A.A.

Clinic Hospital “Russian Railway-Medicine”

Saxena I.

Altai State Medical University

ORCID: 0009-0003-4026-6882

Received:

21.05.2024

Accepted:

29.07.2024

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