Intraoperative neuromonitoring and postoperative bilateral laryngeal paralysis in total thyroidectomy. Systematic review and meta-analysis
Abstract Introduction and objective: Despite being unusual, bilateral paralysis of recurrent laryngeal nerve is a complication that has large morbidity and mortality rates within thyroid surgery. The visual identification of recurrent laryngeal nerve remains the gold standard in the procedure. The main aim is to evaluate if the intraoperative neuromonitoring reduces the bilateral laryngeal paralysis risk during total thyroidectomy, through systematic review and meta-analysis. Method: The method consists of the systematic review of studies that included series of total thyroidectomy with and without neuromonitoring, without date or language restriction in PubMed, BVS, Cochrane, Clinical trials and WoS. The prevalence of bilateral paralysis of recurrent laryngeal nerve was evaluated. A descriptive study of the included variables and a meta-analysis following the aleatory effects model were conducted. Results: A number of 45 studies were selected and analysed into two subgroups: retrospective series (31 studies) and prospective series (14 studies); with a total of 197161 patients. The prospective series resulted homogenous and with low publishing bias, with a total of 11149 patients. In prospective studies, the observed difference between the risk of bilateral paralysis of recurrent laryngeal nerve with and without intraoperative neuromonitoring equates to a RAR of 2.1% and a NNT of 487.15.Conclusions: Neuromonitoring reduces the risk of developing vocal cord palsy.
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Pardal-Refoyo JL, Ochoa-Sangrador C. Lesión bilateral del nervio laríngeo recurrente en tiroidectomía total con o sin neuromonitorización intraoperatoria. Revisión sistemática y metaanálisis. Acta Otorrinolaringol Esp. 2016;67(2):66–74.
Bai B, Chen W. Protective Effects of Intraoperative Nerve Monitoring (IONM) for Recurrent Laryngeal Nerve Injury in Thyroidectomy: Meta-analysis. Sci Rep. 2018;8(1):1–11.
Hayward NJ, Grodski S, Yeung M, Johnson WR, Serpell J. Recurrent laryngeal nerve injury in thyroid surgery: A review. ANZ J Surg. 2013;83(1–2):15–21.
Enomoto K, Uchino S, Watanabe S, Enomoto Y, Noguchi S. Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: Risk factors and outcome analysis. Surg (United States). 2014;155(3):522–8.
Jeannon JP, Orabi AA, Bruch GA, Abdalsalam HA, Simo R. Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: A systematic review. Int J Clin Pract. 2009;63(4):624–9.
Henry BM, Graves MJ, Vikse J. El estado actual de la monitorización neural intraoperatoria intermitente para la prevención de la lesión del nervio laríngeo recurrente durante la tiroidectomía?: una revisión sistemática compatible con PRISMA de metanálisis superpuestos. 2017;663–73.
Motos-Micó JJ, Felices-Montes M. Neuromonitorización intraoperatoria en cirugía tiroidea. Cir Cir. 2017;85(4):312–9.
Witt RL. Recurrent laryngeal nerve electrophysiologic monitoring in thyroid surgery: The standard of care? J Voice. 2005;19(3):497–500.
Pardal-Refoyo JL, Parente-Arias P, Arroyo-Domingo MM, Maza-Solano JM, Granell-Navarro J, Martínez-Salazar JM, et al. Recommendations on the use of neuromonitoring in thyroid and parathyroid surgery. Acta Otorrinolaringol Esp. 2018;69(4):231–42.
The jamovi proyect (2021). Jamovi. (Version 1.6) [Computer Software]. Retrieved from https://www.jamovi.org.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10(1):1–15.
Agha A, Glockzin G, Ghali N, Iesalnieks I, Schlitt HJ. Surgical treatment of substernal goiter: An analysis of 59 patients. Surg Today. 2008;38(6):505–11.
Al-Qurayshi Z, Randolph GW, Alshehri M, Kandil E. Analysis of variations in the use of intraoperative nerve monitoring in thyroid surgery. JAMA Otolaryngol - Head Neck Surg. 2016;142(6):584–9.
Cavicchi O, Caliceti U, Fernandez IJ, Macrì G, Di Lieto C, Marcantoni A, et al. The value of neurostimulation and intraoperative nerve monitoring of inferior laryngeal nerve in thyroid surgery. Otolaryngol - Head Neck Surg. 2009;140(6):866–70.
Chan WF, Lang BHH, Lo CY. The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: A comparative study on 1000 nerves at risk. Surgery. 2006;140(6):866–73.
Chuang YC, Huang SM. Protective effect of intraoperative nerve monitoring against recurrent laryngeal nerve injury during re-exploration of the thyroid. World J Surg Oncol. 2013;11:2–7.
Chung TK, Rosenthal EL, Porterfield JR, Carroll WR, Richman J, Hawn MT. Examining national outcomes after thyroidectomy with nerve monitoring. J Am Coll Surg. 2014;219(4):765–70.
De Danschutter SJR, Schreinemakers JMJ, Smit LHM, Van Der Laan L, Nuytinck HKS. Thyroid surgery and the usefulness of intraoperative neuromonitoring, a single center study. J Investig Surg. 2015;28(2):86–94.
De Falco M, Santangelo G, Del Giudice S, Gallucci F, Parmeggiani U. Double probe intraoperative neuromonitoring with a standardized method in thyroid surgery. Int J Surg. 2014;12(July 2010):140–4.
Francis DO, Pearce EC, Ni S, Garrett CG, Penson DF. Epidemiology of vocal fold paralyses after total thyroidectomy for well-differentiated thyroid cancer in a medicare population. Otolaryngol - Head Neck Surg (United States). 2014;150(4):548–57.
Frattini F, Mangano A, Boni L, Rausei S, Biondi A, Dionigi G. Intraoperative neuromonitoring for thyroid malignancy surgery: Technical notes and results from a retrospective series. Updates Surg. 2010;62(3–4):183–7.
Godballe C, Madsen AR, Sørensen CH, Schytte S, Trolle W, Helweg-Larsen J, et al. Risk factors for Recurrent nerve palsy after thyroid surgery: A national study of patients treated at Danish departments of ENT Head and Neck Surgery. Eur Arch Oto-Rhino-Laryngology. 2014;271(8):2267–76.
Gremillion G, Fatakia A, Dornelles A, Amedee RG. Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery: Is it worth the cost? Ochsner J. 2012;12(4):363–6.
Alesina PF, Hinrichs J, Meier B, Cho EY, Bolli M, Walz MK. Intraoperative neuromonitoring for surgical training in thyroid surgery: Its routine use allows a safe operation instead of lack of experienced mentoring. World J Surg. 2014;38(3):592–8.
Gür EO, Haciyanli M, Karaisli S, Haciyanli S, Kamer E, Acar T, et al. Intraoperative nerve monitoring during thyroidectomy: Evaluation of signal loss, prognostic value and surgical strategy. Ann R Coll Surg Engl. 2019;101(8):589–95.
Kai H, Xixia L, Miaoyun L, Qinchang C, Xinzhi P, Dingyuan L, et al. Intraoperative nerve monitoring reduces recurrent laryngeal nerve injury in geriatric patients undergoing thyroid surgery. Acta Otolaryngol. 2017;137(12):1275–80.
Kartal K, Aygun N, Celayir MF, Besler E, Citgez B, Isgor A, et al. Intraoperative Neuromonitoring in Thyroid Surgery: An Efficient Tool to Avoid Bilateral Vocal Cord Palsy. Ear, Nose Throat J. 2020;(4):1–6.
Page C, Cuvelier P, Biet A, Strunski V. Value of intra-operative neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy for benign goitre. J Laryngol Otol. 2015;129(6):553–7.
Prokopakis E, Kaprana A, Velegrakis S, Panagiotaki I, Chatzakis N, Iro H, et al. Intraoperative recurrent laryngeal nerve monitoring in revision thyroidectomy. Eur Arch Oto-Rhino-Laryngology. 2013;270(9):2521–4.
Robertson ML, Steward DL, Gluckman JL, Welge J. Continuous laryngeal nerve integrity monitoring during thyroidectomy: Does it reduce risk of injury? Otolaryngol - Head Neck Surg. 2004;131(5):596–600.
Sanguinetti A, Parmeggiani D, Lucchini R, Monacelli M, Triola R, Avenia S, et al. Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery Evaluation of its use in terms of «spending review». Ann Ital Chir. 2014;85:418–21.
Shindo M, Chheda NN. Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Arch Otolaryngol - Head Neck Surg. 2007;133(5):481–5.
Staubitz JI, Watzka F, Poplawski A, Riss P, Clerici T, Bergenfelz A, et al. Effect of intraoperative nerve monitoring on postoperative vocal cord palsy rates after thyroidectomy: European multicentre registry-based study. BJS open. 2020;4(5):821–9.
Thong G, Brophy C, Sheahan P. Use of intraoperative neural monitoring for prognostication of recovery of vocal mobility and reduction of permanent vocal paralysis after thyroidectomy. Head Neck. 2021;43(1):7–14.
Alesina PF, Rolfs T, Hommeltenberg S, Hinrichs J, Meier B, Mohmand W, et al. Intraoperative neuromonitoring does not reduce the incidence of recurrent laryngeal nerve palsy in thyroid reoperations: Results of a retrospective comparative analysis. World J Surg. 2012;36(6):1348–53.
Vasileiadis I, Karatzas T, Charitoudis G, Karakostas E, Tseleni-Balafouta S, Kouraklis G. Association of intraoperative neuromonitoring with reduced recurrent laryngeal nerve injury in patients undergoing total thyroidectomy. JAMA Otolaryngol - Head Neck Surg. 2016;142(10):994–1001.
Barczy?ski M, Konturek A, Pragacz K, Papier A, Stopa M, Nowak W. Intraoperative nerve monitoring can reduce prevalence of recurrent laryngeal nerve injury in thyroid reoperations: Results of a retrospective cohort study. World J Surg. 2014;38(3):599–606.
Bergenfelz A, Salem AF, Jacobsson H, Nordenström E, Almquist M, Wallin GW, et al. Risk of recurrent laryngeal nerve palsy in patients undergoing thyroidectomy with and without intraoperative nerve monitoring. Br J Surg. 2016;103(13):1828–38.
Brajcich BC, McHenry CR. The utility of intraoperative nerve monitoring during thyroid surgery. J Surg Res. 2016;204(1):29–33.
Brauckhoff M, Gimm O, Thanh PN, Brauckhoff K, Ukkat J, Thomusch O, et al. First experiences in intraoperative neurostimulation of the recurrent laryngeal nerve during thyroid surgery of children and adolescents. J Pediatr Surg. 2002;37(10):1414–8.
Calò PG, Pisano G, Medas F, Tatti A, Pittau MR, Demontis R, et al. Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery: Is it really useful? Clin Ter. 2013;164(3):193–8.
Calò PG, Medas F, Erdas E, Pittau MR, Demontis R, Pisano G, et al. Role of intraoperative neuromonitoring of recurrent laryngeal nerves in the outcomes of surgery for thyroid cancer. Int J Surg. 2014;12:213–7.
Anuwong A, Lavazza M, Kim HY, Wu CW, Rausei S, Pappalardo V, et al. Recurrent laryngeal nerve management in thyroid surgery: consequences of routine visualization, application of intermittent, standardized and continuous nerve monitoring. Updates Surg. 2016;68(4):331–41.
Barczy?ski M, Konturek A, Cicho? S. Randomized clinical trial of visualization wersus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. 2009;96(3):240–6.
Netto I de P, Vartarian JG, Ferraz PRR, Salgado P, de Azevedo JBM, Toledo RN, et al. Vocal fold immobility after thyroidectomy with intraoperative recurrent laryngeal nerve monitoring. Sao Paulo Med J. 2007;125(3):186–90.
Sari S, Erbil Y, Sümer A, Agcaoglu O, Bayraktar A, Issever H, et al. Evaluation of recurrent laryngeal nerve monitoring in thyroid surgery. Int J Surg. 2010;8(6):474–8.
Thomusch O, Sekulla C, Walls G, Machens A, Dralle H. Intraoperative neuromonitoring of surgery for benign goiter. Am J Surg. 2002;183(6):673–8.
Wojtczak B, Sutkowski K, Kaliszewski K, G?ód M, Barczy?ski M. Experience with intraoperative neuromonitoring of the recurrent laryngeal nerve improves surgical skills and outcomes of non-monitored thyroidectomy. Langenbeck’s Arch Surg. 2017;402(4):709–17.
Calò PG, Medas F, Gordini L, Podda F, Erdas E, Pisano G, et al. Interpretation of intraoperative recurrent laryngeal nerve monitoring signals: The importance of a correct standardization. Int J Surg. 2016;28:S54–8.
Caló PG, Pisano G, Medas F, Pittau MR, Gordini L, Demontis R, et al. Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: Experience of 2034 consecutive patients. J Otolaryngol - Head Neck Surg. 2014;43(1):1–7.
Cavicchi O, Caliceti U, Fernández IJ, Ceroni AR, Marcantoni A, Sciascia S, Sottili S, Piccin O. Laryngeal neuromonitoring and neurostimulation versus neurostimulation alone in thyroid surgery: a randomized clinical trial. Wiley Online Libr. 2011;34:141–5.
Dionigi G, Boni L, Rovera F, Bacuzzi A, Dionigi R. Neuromonitoring and video-assisted thyroidectomy: A prospective, randomized case-control evaluation. Surg Endosc. 2009;23(5):996–1003.
Duclos A, Lifante JC, Ducarroz S, Soardo P, Colin C, Peix JL. Influence of intraoperative neuromonitoring on surgeons’ technique during thyroidectomy. World J Surg. 2011;35(4):773–8.
Kadakia S, Mourad M, Hu S, Brown R, Lee T, Ducic Y. Utility of intraoperative nerve monitoring in thyroid surgery: 20-year experience with 1418 cases. Oral Maxillofac Surg. 2017;21(3):335–9.
Lombardi CP, De Waure C, Mariani M, Carnassale G, D’Amore A, Traini E, et al. Efficacy of continuous neuromonitoring in thyroid surgery: Preliminary report of a single-center experience. Gland Surg. 2019;8(4):336–42.
Mirallié É, Caillard C, Pattou F, Brunaud L, Hamy A, Dahan M, et al. Does intraoperative neuromonitoring of recurrent nerves have an impact on the postoperative palsy rate? Results of a prospective multicenter study. Surg (United States). 2018;163(1):124–9.
Bai B, Chen W. Protective Effects of Intraoperative Nerve Monitoring (IONM) for Recurrent Laryngeal Nerve Injury in Thyroidectomy: Meta-analysis. Sci Rep. 2018;8(1):1–11.
Hayward NJ, Grodski S, Yeung M, Johnson WR, Serpell J. Recurrent laryngeal nerve injury in thyroid surgery: A review. ANZ J Surg. 2013;83(1–2):15–21.
Enomoto K, Uchino S, Watanabe S, Enomoto Y, Noguchi S. Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: Risk factors and outcome analysis. Surg (United States). 2014;155(3):522–8.
Jeannon JP, Orabi AA, Bruch GA, Abdalsalam HA, Simo R. Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: A systematic review. Int J Clin Pract. 2009;63(4):624–9.
Henry BM, Graves MJ, Vikse J. El estado actual de la monitorización neural intraoperatoria intermitente para la prevención de la lesión del nervio laríngeo recurrente durante la tiroidectomía?: una revisión sistemática compatible con PRISMA de metanálisis superpuestos. 2017;663–73.
Motos-Micó JJ, Felices-Montes M. Neuromonitorización intraoperatoria en cirugía tiroidea. Cir Cir. 2017;85(4):312–9.
Witt RL. Recurrent laryngeal nerve electrophysiologic monitoring in thyroid surgery: The standard of care? J Voice. 2005;19(3):497–500.
Pardal-Refoyo JL, Parente-Arias P, Arroyo-Domingo MM, Maza-Solano JM, Granell-Navarro J, Martínez-Salazar JM, et al. Recommendations on the use of neuromonitoring in thyroid and parathyroid surgery. Acta Otorrinolaringol Esp. 2018;69(4):231–42.
The jamovi proyect (2021). Jamovi. (Version 1.6) [Computer Software]. Retrieved from https://www.jamovi.org.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10(1):1–15.
Agha A, Glockzin G, Ghali N, Iesalnieks I, Schlitt HJ. Surgical treatment of substernal goiter: An analysis of 59 patients. Surg Today. 2008;38(6):505–11.
Al-Qurayshi Z, Randolph GW, Alshehri M, Kandil E. Analysis of variations in the use of intraoperative nerve monitoring in thyroid surgery. JAMA Otolaryngol - Head Neck Surg. 2016;142(6):584–9.
Cavicchi O, Caliceti U, Fernandez IJ, Macrì G, Di Lieto C, Marcantoni A, et al. The value of neurostimulation and intraoperative nerve monitoring of inferior laryngeal nerve in thyroid surgery. Otolaryngol - Head Neck Surg. 2009;140(6):866–70.
Chan WF, Lang BHH, Lo CY. The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: A comparative study on 1000 nerves at risk. Surgery. 2006;140(6):866–73.
Chuang YC, Huang SM. Protective effect of intraoperative nerve monitoring against recurrent laryngeal nerve injury during re-exploration of the thyroid. World J Surg Oncol. 2013;11:2–7.
Chung TK, Rosenthal EL, Porterfield JR, Carroll WR, Richman J, Hawn MT. Examining national outcomes after thyroidectomy with nerve monitoring. J Am Coll Surg. 2014;219(4):765–70.
De Danschutter SJR, Schreinemakers JMJ, Smit LHM, Van Der Laan L, Nuytinck HKS. Thyroid surgery and the usefulness of intraoperative neuromonitoring, a single center study. J Investig Surg. 2015;28(2):86–94.
De Falco M, Santangelo G, Del Giudice S, Gallucci F, Parmeggiani U. Double probe intraoperative neuromonitoring with a standardized method in thyroid surgery. Int J Surg. 2014;12(July 2010):140–4.
Francis DO, Pearce EC, Ni S, Garrett CG, Penson DF. Epidemiology of vocal fold paralyses after total thyroidectomy for well-differentiated thyroid cancer in a medicare population. Otolaryngol - Head Neck Surg (United States). 2014;150(4):548–57.
Frattini F, Mangano A, Boni L, Rausei S, Biondi A, Dionigi G. Intraoperative neuromonitoring for thyroid malignancy surgery: Technical notes and results from a retrospective series. Updates Surg. 2010;62(3–4):183–7.
Godballe C, Madsen AR, Sørensen CH, Schytte S, Trolle W, Helweg-Larsen J, et al. Risk factors for Recurrent nerve palsy after thyroid surgery: A national study of patients treated at Danish departments of ENT Head and Neck Surgery. Eur Arch Oto-Rhino-Laryngology. 2014;271(8):2267–76.
Gremillion G, Fatakia A, Dornelles A, Amedee RG. Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery: Is it worth the cost? Ochsner J. 2012;12(4):363–6.
Alesina PF, Hinrichs J, Meier B, Cho EY, Bolli M, Walz MK. Intraoperative neuromonitoring for surgical training in thyroid surgery: Its routine use allows a safe operation instead of lack of experienced mentoring. World J Surg. 2014;38(3):592–8.
Gür EO, Haciyanli M, Karaisli S, Haciyanli S, Kamer E, Acar T, et al. Intraoperative nerve monitoring during thyroidectomy: Evaluation of signal loss, prognostic value and surgical strategy. Ann R Coll Surg Engl. 2019;101(8):589–95.
Kai H, Xixia L, Miaoyun L, Qinchang C, Xinzhi P, Dingyuan L, et al. Intraoperative nerve monitoring reduces recurrent laryngeal nerve injury in geriatric patients undergoing thyroid surgery. Acta Otolaryngol. 2017;137(12):1275–80.
Kartal K, Aygun N, Celayir MF, Besler E, Citgez B, Isgor A, et al. Intraoperative Neuromonitoring in Thyroid Surgery: An Efficient Tool to Avoid Bilateral Vocal Cord Palsy. Ear, Nose Throat J. 2020;(4):1–6.
Page C, Cuvelier P, Biet A, Strunski V. Value of intra-operative neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy for benign goitre. J Laryngol Otol. 2015;129(6):553–7.
Prokopakis E, Kaprana A, Velegrakis S, Panagiotaki I, Chatzakis N, Iro H, et al. Intraoperative recurrent laryngeal nerve monitoring in revision thyroidectomy. Eur Arch Oto-Rhino-Laryngology. 2013;270(9):2521–4.
Robertson ML, Steward DL, Gluckman JL, Welge J. Continuous laryngeal nerve integrity monitoring during thyroidectomy: Does it reduce risk of injury? Otolaryngol - Head Neck Surg. 2004;131(5):596–600.
Sanguinetti A, Parmeggiani D, Lucchini R, Monacelli M, Triola R, Avenia S, et al. Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery Evaluation of its use in terms of «spending review». Ann Ital Chir. 2014;85:418–21.
Shindo M, Chheda NN. Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Arch Otolaryngol - Head Neck Surg. 2007;133(5):481–5.
Staubitz JI, Watzka F, Poplawski A, Riss P, Clerici T, Bergenfelz A, et al. Effect of intraoperative nerve monitoring on postoperative vocal cord palsy rates after thyroidectomy: European multicentre registry-based study. BJS open. 2020;4(5):821–9.
Thong G, Brophy C, Sheahan P. Use of intraoperative neural monitoring for prognostication of recovery of vocal mobility and reduction of permanent vocal paralysis after thyroidectomy. Head Neck. 2021;43(1):7–14.
Alesina PF, Rolfs T, Hommeltenberg S, Hinrichs J, Meier B, Mohmand W, et al. Intraoperative neuromonitoring does not reduce the incidence of recurrent laryngeal nerve palsy in thyroid reoperations: Results of a retrospective comparative analysis. World J Surg. 2012;36(6):1348–53.
Vasileiadis I, Karatzas T, Charitoudis G, Karakostas E, Tseleni-Balafouta S, Kouraklis G. Association of intraoperative neuromonitoring with reduced recurrent laryngeal nerve injury in patients undergoing total thyroidectomy. JAMA Otolaryngol - Head Neck Surg. 2016;142(10):994–1001.
Barczy?ski M, Konturek A, Pragacz K, Papier A, Stopa M, Nowak W. Intraoperative nerve monitoring can reduce prevalence of recurrent laryngeal nerve injury in thyroid reoperations: Results of a retrospective cohort study. World J Surg. 2014;38(3):599–606.
Bergenfelz A, Salem AF, Jacobsson H, Nordenström E, Almquist M, Wallin GW, et al. Risk of recurrent laryngeal nerve palsy in patients undergoing thyroidectomy with and without intraoperative nerve monitoring. Br J Surg. 2016;103(13):1828–38.
Brajcich BC, McHenry CR. The utility of intraoperative nerve monitoring during thyroid surgery. J Surg Res. 2016;204(1):29–33.
Brauckhoff M, Gimm O, Thanh PN, Brauckhoff K, Ukkat J, Thomusch O, et al. First experiences in intraoperative neurostimulation of the recurrent laryngeal nerve during thyroid surgery of children and adolescents. J Pediatr Surg. 2002;37(10):1414–8.
Calò PG, Pisano G, Medas F, Tatti A, Pittau MR, Demontis R, et al. Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery: Is it really useful? Clin Ter. 2013;164(3):193–8.
Calò PG, Medas F, Erdas E, Pittau MR, Demontis R, Pisano G, et al. Role of intraoperative neuromonitoring of recurrent laryngeal nerves in the outcomes of surgery for thyroid cancer. Int J Surg. 2014;12:213–7.
Anuwong A, Lavazza M, Kim HY, Wu CW, Rausei S, Pappalardo V, et al. Recurrent laryngeal nerve management in thyroid surgery: consequences of routine visualization, application of intermittent, standardized and continuous nerve monitoring. Updates Surg. 2016;68(4):331–41.
Barczy?ski M, Konturek A, Cicho? S. Randomized clinical trial of visualization wersus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. 2009;96(3):240–6.
Netto I de P, Vartarian JG, Ferraz PRR, Salgado P, de Azevedo JBM, Toledo RN, et al. Vocal fold immobility after thyroidectomy with intraoperative recurrent laryngeal nerve monitoring. Sao Paulo Med J. 2007;125(3):186–90.
Sari S, Erbil Y, Sümer A, Agcaoglu O, Bayraktar A, Issever H, et al. Evaluation of recurrent laryngeal nerve monitoring in thyroid surgery. Int J Surg. 2010;8(6):474–8.
Thomusch O, Sekulla C, Walls G, Machens A, Dralle H. Intraoperative neuromonitoring of surgery for benign goiter. Am J Surg. 2002;183(6):673–8.
Wojtczak B, Sutkowski K, Kaliszewski K, G?ód M, Barczy?ski M. Experience with intraoperative neuromonitoring of the recurrent laryngeal nerve improves surgical skills and outcomes of non-monitored thyroidectomy. Langenbeck’s Arch Surg. 2017;402(4):709–17.
Calò PG, Medas F, Gordini L, Podda F, Erdas E, Pisano G, et al. Interpretation of intraoperative recurrent laryngeal nerve monitoring signals: The importance of a correct standardization. Int J Surg. 2016;28:S54–8.
Caló PG, Pisano G, Medas F, Pittau MR, Gordini L, Demontis R, et al. Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: Experience of 2034 consecutive patients. J Otolaryngol - Head Neck Surg. 2014;43(1):1–7.
Cavicchi O, Caliceti U, Fernández IJ, Ceroni AR, Marcantoni A, Sciascia S, Sottili S, Piccin O. Laryngeal neuromonitoring and neurostimulation versus neurostimulation alone in thyroid surgery: a randomized clinical trial. Wiley Online Libr. 2011;34:141–5.
Dionigi G, Boni L, Rovera F, Bacuzzi A, Dionigi R. Neuromonitoring and video-assisted thyroidectomy: A prospective, randomized case-control evaluation. Surg Endosc. 2009;23(5):996–1003.
Duclos A, Lifante JC, Ducarroz S, Soardo P, Colin C, Peix JL. Influence of intraoperative neuromonitoring on surgeons’ technique during thyroidectomy. World J Surg. 2011;35(4):773–8.
Kadakia S, Mourad M, Hu S, Brown R, Lee T, Ducic Y. Utility of intraoperative nerve monitoring in thyroid surgery: 20-year experience with 1418 cases. Oral Maxillofac Surg. 2017;21(3):335–9.
Lombardi CP, De Waure C, Mariani M, Carnassale G, D’Amore A, Traini E, et al. Efficacy of continuous neuromonitoring in thyroid surgery: Preliminary report of a single-center experience. Gland Surg. 2019;8(4):336–42.
Mirallié É, Caillard C, Pattou F, Brunaud L, Hamy A, Dahan M, et al. Does intraoperative neuromonitoring of recurrent nerves have an impact on the postoperative palsy rate? Results of a prospective multicenter study. Surg (United States). 2018;163(1):124–9.
Estébanez-Peláez, G., Pardal-Refoyo, J. L., González-Sánchez, E., & Ferreira-Cendón, S. (2022). Intraoperative neuromonitoring and postoperative bilateral laryngeal paralysis in total thyroidectomy. Systematic review and meta-analysis. Revista ORL, 13(4), e28102. https://doi.org/10.14201/orl.28102
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- Enrique González-Sánchez, Presentación del XXV Congreso de la Sociedad Otorrinolaringológica de Castilla y León, Cantabria y La Rioja. Salamanca 1 al 3 de junio de 2017 , Revista ORL: SALAMANCA 2017
- Sofía Ferreira-Cendón, Nasosinusal Endoscopic and Skull Base Surgery. Abroad Observership , Revista ORL: Vol. 13 No. S2 (2022): XXVIII Congreso de la Sociedad Otorrinolaringológica de Castilla y León, Cantabria y La Rioja Valladolid 2, 3 y 4 de junio de 2022
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