Does the Use of Intraoperative Neuromonitoring during Thyroid and Parathyroid Surgery Reduce the Incidence of Recurrent Laryngeal Nerve Injuries? A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
Inclusion/Exclusion Criteria
3. Results
Author [Citation] | Year | Country | Dates of Study | Type of Study | Type of Control | NAR (Patients) | Postop Laryngoscopy | Definition of Permanent Injury | Number of Surgeons | % Female Patients | % Cancer Operations | % Total Thyroidectomy |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Adamczyk [19] | 2015 | Poland | 1992–2005 | R | C | 120 (80) | Yes | 6 months | M | 100 | NS | 100 |
Agha [49] | 2008 | Germany | 2012–2017 | R | C | (59) | Yes | NS | M | 61 | NS | 100 |
Akici [50] | 2020 | Turkey | 2004–2012 | R | H | (273) | Yes | 6 months | S | 86 | 0 | 100 |
Akkari [51] | 2014 | France | 2005–2012 | R | C | (90) | NS | NS | NS | 75 | NS | 44.6 |
Alesina [52] | 2014 | Germany | 2002–2014 | PNR | C | 1708 (1114) | Yes | 6 months | M | 75 | 9 | 47 |
Anuwong [48] | 2016 | Italy | 2003–2007 | R | H | NS | Yes | NS | S | 79 | 19 | NS |
Atallah [53] | 2009 | France | 2006–2007 | R | C | 421 (261) | Yes | 12 months | M | 77 | 7 | 60 |
Barczyński [54] | 2009 | Poland | 1993–2012 | PR | C | 2000 (1000) | Yes | 12 months | M | 91 | 12 | 75 |
Barczyński [55] | 2014 | Poland | 1993–2012 | R | C | 1326 (854) | Yes | 12 months | M | 81 | 28 | 39 |
Bonati [56] | 2022 | Italy | 2009–2015 | R | H | 1212 (638) | No | NS | M | 76 | 95 | 90 |
Brajcich [57] | 2016 | USA | 1995–2002 | R | H | 1048 (627) | Yes | 12 months | S | 83 | 20 | 67 |
Brauckhoff [23] | 2002 | Germany | 2007–2014 | R | H | 169 (97) | Yes | NS | M | 58 | 77 | NS |
Calò [5] | 2017 | Italy | 2002–2005 | R | H | 4730 (2365) | Selective | 12 months | M | 80 | 31 | 100 |
Chan [58] | 2006 | Hong Kong | 2001–2010 | R | C | 1000 (639) | Yes | 12 months | M | 79 | 22 | 61 |
Chuang [59] | 2013 | Taiwan | 2009–2012 | R | H | 83 (71) | No | NS | S | 83 | 24 | 57 |
DeDanschutter [24] | 2015 | Netherlands | 2014–2016 | R | H | 170 (147) | Yes | 12 months | M | 86 | 14 | 16 |
Demiryas [60] | 2018 | Turkey | 1998–2001 | R | C | 370 (191) | Yes | 12 months | S | 9 | NS | 46 |
Dralle [16] | 2004 | Germany | 2008–2009 | PNR | C | 23,349 | Yes | 6 months | M | 78 | 7 | 69 |
Duclos [61] | 2011 | France | 2013–2018 | PNR | C | (686) | Yes | NS | M | 78 | 21 | 76 |
Dudley [62] | 2021 | USA | 2008–2016 | R | C | (107) | No | 3 weeks | M | 58 | NS | NS |
Ercetin [25] | 2019 | Turkey | NS | PR | C | 1496 (748) | Yes | 12 months | M | 89 | NS | NS |
Frattini [63] | 2010 | Italy | 2007–2010 | R | NS | 304 (152) | Yes | NS | NS | 56 | 100 | 100 |
Gremillion [64] | 2012 | USA | 2007–2010 | R | C | 162 (119) | NS | NS | S | NS | NS | 36 |
Grishaeva [65] | 2022 | Germany | 2007–2011 | R | H | 2720 (1963) | Yes | 6 months | M | 77 | 0 | 38 |
Hayward [9] | 2013 | Australia | 2012–2014 | R | C | 3736 | NS | NS | NS | NS | 18 | 53 |
Hei [66] | 2016 | China | 1997–2016 | PR | C | 84 (70) | Yes | 6 months | S | 77 | 77 | 26 |
Kadakia [18] | 2017 | USA | 2013–2016 | R | H | (1418) | Yes | 8 months | S | 68 | 57 | NS |
Kai [67] | 2017 | China | 1987–2008 | R | C | 836 (552) | Yes | 6 months | M | 22 | 25 | 89 |
Karakas [68] | 2013 | Germany | 2014–2016 | R | H | (111) | NS | NS | M | 65 | NS | NS |
Kartal [20] | 2021 | Turkey | 2009–2019 | R | C | 839 (493) | Yes | 6 months | M | 79 | 19 | 70 |
Kim [6] | 2020 | Korea | 2011–2014 | PNR | C | 133 (121) | Yes | 12 months | M | 72 | 100 | 100 |
Lee [69] | 2017 | Australia | 2008–2018 | PNR | H | 1583 (990) | Yes | NS | S | 80 | 18 | 60 |
Legre [17] | 2020 | France | 2014–2018 | R | C | 77 (47) | Selective | 6 months | M | 62 | 13 | 38 |
Leow [70] | 2020 | Singapore | 2012–2017 | R | C | 301 (193) | Yes | 6 months | M | 74 | 25 | 15 |
Ling [71] | 2020 | China | 2010–2016 | R | C | 1696 (1033) | Yes | 6 months | M | 73 | 46 | 76 |
Long [72] | 2018 | China | 2012–2014 | R | C | (435) | Yes | 6 months | M | 32 | 100 | 100 |
Mirallie [73] | 2018 | France | 1997–2016 | PNR | C | 2633 (1328) | Yes | 6 months | M | 80 | 22 | 100 |
Mourad [74] | 2017 | USA | 1997–2016 | R | H | (213) | Yes | 7 months | S | 72 | 0 | 0 |
Netto [75] | 2007 | Brazil | 2003–2006 | R | H | 327 (204) | Yes | 3 months | M | 93 | 58 | 63 |
Page [76] | 2015 | France | 2001–2010 | R | H | 1534 (767) | Yes | 12 months | M | 82 | NS | 100 |
Pei [77] | 2021 | China | 2010–2020 | R | H | 159 (109) | Yes | NS | M | 56 | 47 | NS |
Polat [78] | 2015 | Turkey | 2010–2012 | PNR | C | 178 (94) | Yes | NS | M | 79 | 27 | 76 |
Prokopakis [30] | 2013 | Greece | 2004–2011 | R | C | 121 (97) | No | 4 months | M | 79 | 87 | 25 |
Ritter [26] | 2021 | Israel | 2001–2019 | R | C | 183 (113) | Yes | 12 months | M | 75 | 57 | 43 |
Robertson [79] | 2004 | USA | 1999–2002 | R | C | 236 (165) | Yes | NS | M | 77 | 33 | NS |
Sanguinetti [28] | 2014 | Italy | 2012 | R | C | 700 (350) | Yes | NS | M | NS | NS | 100 |
Sari [29] | 2010 | Turkey | 2007–2009 | PR | C | 409 (237) | Yes | 12 months | M | 82 | 17 | 79 |
Sharif [80] | 2017 | Pakistan | 2014–2017 | R | C | 400 (200) | Yes | 6 months | M | NS | NS | 100 |
Shindo [81] | 2007 | USA | 1998–2005 | R | C | 1043 (684) | Yes | NS | S | NS | 55 | 52 |
Sopinski [82] | 2017 | Poland | 2014–2016 | R | C | 133 (80) | NS | NS | M | 95 | 0 | 66 |
Stevens [83] | 2012 | USA | 2004–2008 | PNR | C | 143 (91) | No | 6 months | M | 59 | 41 | 57 |
Teksoz [27] | 2015 | Turkey | 2011–2012 | PR | C | 322 (161) | Yes | 6 months | M | 76 | 34 | 100 |
Terris [31] | 2007 | USA | 2004–2006 | R | C | 176 (137) | Yes | 6 months | S | NS | 18 | 28 |
Thong [84] | 2021 | Ireland | 2009–2019 | PNR | H | 1539 (1001) | Yes | 6 months | S | 81 | 23 | 55 |
Vasileiadis [10] | 2016 | Greece | 2002–2012 | R | C | 5112 (2556) | Yes | 12 months | M | 79 | NS | 100 |
Witt [85] | 2005 | USA | 1998–2003 | R | C | 190 | NS | 12 months | S | NS | NS | 44 |
Wojtczak [8] | 2017 | Poland | 2011–2014 | R | C | 105 (61) | Yes | 12 months | M | 87 | 20 | 85 |
Yarbrough [22] | 2004 | USA | 1998–2003 | R | H | 151 (111) | Selective | NS | M | 63 | 66 | 4.5 |
Zhang [7] | 2020 | China | 2018 | R | C | 280 (200) | Yes | 6 months | M | 83 | 100 | 78 |
Zhou [47] | 2019 | China | 2009–2014 | R | C | 418 (209) | Yes | 12 months | M | 62 | 2 | 91 |
3.1. Meta-Analysis of All Studies Assessing Permanent Nerve Injury Categorized by NAR and per Patient
3.2. Meta-Analysis of All Studies Assessing Total Nerve Injuries Categorized by NAR and per Patient
3.3. Meta-Analysis of Randomized Controlled Trials Assessing Permanent and Total Number of Nerve Injuries Categorized by NAR
3.4. Meta-Analysis of Studies with Documented Post-Operative Laryngoscopy Assessing Permanent and Total RLN Injuries Categorized by Nerves at Risk
3.5. Meta-Analysis of All Studies with Contemporaneous Controls Assessing Permanent and Total RLN Injuries Categorized by Nerves at Risk
3.6. Meta-Analysis of All Studies with Contemporaneous Controls and Documented Postoperative Laryngoscopy Assessing Permanent and Total RLN Injuries Categorized by Nerves at Risk
3.7. Risk of Bias Assessment
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author | Year | Favors IONM in Reducing Permanent RLN Injuries | Favors IONM in Reducing Transient RLN Injuries | Favors IONM in Reducing Total RLN Injuries |
---|---|---|---|---|
Bai [32] | 2018 | Yes | Yes | Yes |
Cleere [33] | 2022 | No | No | NS |
Cirocchi [34] | 2019 | No | No | No |
Davey [35] | 2022 | No | No | No |
Higgins [36] | 2011 | No | No | No |
Kim [37] | 2021 | Yes | Yes | Yes |
Lombardi [38] | 2016 | No | NS | NS |
Pisanu [39] | 2014 | No | No | No |
Rulli [40] | 2014 | No | Yes | NS |
Sanabria [41] | 2013 | No | No | NS |
Sun (reoperations) [42] | 2017 | Yes | No | Yes |
Wong (high-risk patients) (Random effects analysis) [43] | 2017 | No | No | Yes |
Wong (high-risk patients) (Fixed effects analysis) [43] | 2017 | No | Yes | Yes |
Yang [44] | 2017 | No | No | No |
Zheng [45] | 2013 | No | Yes | Yes |
Category | Type of Injury | Assessment | % Injury IONM | % Injury No IONM | OR (95% CI) IONM vs. No IONM |
---|---|---|---|---|---|
All studies | Permanent | NAR | 0.69 | 1.0 | 0.66 (0.56–0.79) |
Patient | 1.2 | 1.8 | 0.61 (0.49–0.76) | ||
All studies | Total injuries | NAR | 3.0 | 4.2 | 0.72 (0.65–0.79) |
Patient | 5.2 | 6.9 | 0.71 (0.64–0.79) | ||
Randomized | Permanent | NAR | 0.47 | 0.65 | 0.73 (0.33–1.61) |
Total | NAR | 2.6 | 3.4 | 0.74 (0.52–1.06) | |
Postoperative laryngoscopy | Permanent | NAR | 0.75 | 1.0 | 0.67 (0.55–0.80) |
Total | NAR | 3.4 | 4.6 | 0.68 (0.61–0.76) | |
Contemporaneous controls | Permanent | NAR | 0.72 | 1.1 | 0.67 (0.55–0.82) |
Total | NAR | 2.9 | 4.9 | 0.65 (0.57–0.74) | |
Contemporaneous controls AND laryngoscopy | Permanent | NAR | 0.78 | 1.1 | 0.69 (0.56–0.84) |
Total | NAR | 3.1 | 5.0 | 0.63 (0.55–0.72) |
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Saxe, A.; Idris, M.; Gemechu, J. Does the Use of Intraoperative Neuromonitoring during Thyroid and Parathyroid Surgery Reduce the Incidence of Recurrent Laryngeal Nerve Injuries? A Systematic Review and Meta-Analysis. Diagnostics 2024, 14, 860. https://doi.org/10.3390/diagnostics14090860
Saxe A, Idris M, Gemechu J. Does the Use of Intraoperative Neuromonitoring during Thyroid and Parathyroid Surgery Reduce the Incidence of Recurrent Laryngeal Nerve Injuries? A Systematic Review and Meta-Analysis. Diagnostics. 2024; 14(9):860. https://doi.org/10.3390/diagnostics14090860
Chicago/Turabian StyleSaxe, Andrew, Mohamed Idris, and Jickssa Gemechu. 2024. "Does the Use of Intraoperative Neuromonitoring during Thyroid and Parathyroid Surgery Reduce the Incidence of Recurrent Laryngeal Nerve Injuries? A Systematic Review and Meta-Analysis" Diagnostics 14, no. 9: 860. https://doi.org/10.3390/diagnostics14090860