APPLICATION OF NEUROMONITORING IN THE PRACTICE OF THYROID SURGERY

Abstract

Actuality. Systematic reviews and meta-analyses of studies comparing intervention with intraoperative neuromonitoring with the identification of recurrent laryngeal nerve in the absence of intraoperative neuromonitoring have been published. Data from these reviews are conflicting. Some authors insist that intraoperative neuromonitoring reduces both temporary and permanent damage to the recurrent laryngeal nerve. Other researchers did not find a significant reduction in the frequency of damage to the recurrent laryngeal nerve, instead, they indicate a greater comfort for the surgeon when performing the intervention. The purpose of the review was to assess the main trends in the use of neuromonitoring in thyroid surgery. Material and methods. The information search was carried out in PubMed, EMBASE, Ovid EBMR, UpToDate, Cochrane Library databases. Search depth – 5 years. Key words were “intraoperative neuromonitoring”, “thyroid surgery”, “recurrent laryngeal nerve”. 67 sources were analyzed, from which 29 publications were selected for further analysis. Results and discussion. The epidemiology of traumatic laryngeal nerve injuries, their etiology and clinical manifestations are considered. The most common mechanisms of recurrent laryngeal nerve injury are traction (for example, during removal of a retrosternal goiter); incision or electrocoagulation is much less common. The history of the development of the issue, modern trends in the application of intraoperative monitoring have been studied. The advantages of using intraoperative monitoring for identification of laryngeal nerves over conventional imaging are discussed. It is shown that the efficiency of identification of the recurrent laryngeal nerve reaches 98–100%. It is emphasized that the introduction of intraoperative monitoring into surgical practice in the treatment of thyroid gland diseases prevents trauma to the thyroid gland and improves the life quality.