NEUROMONITORING THE BRANCHES OF THE RECURRENT NERVE DURING THYROIDECTOMY

The lesions of the laryngeal nerves are the most severe long term complications after thyroidectomy. Visual identification of the recurrent laryngeal nerve during thyroid surgery has been recommended in many studies as the golden standard of RLN treatment. The non recurrent laryngeal nerve should always be taken into consideration in order to avoid accidental injury during thyroid surgery. Laryngeal recurrent nerve can be difficult to identify because of rare anatomical variants, extra laryngeal branches, or in complicated thyroid operations, such as voluminous goiter or thyroid cancer. Intraoperative nerve monitoring is secure for the patient, easy to use and useful in showing the integrity of laryngeal recurrent nerve, both during and after surgery. The Departament of Surgery, Valcea Country Hospital, from January 2014 to April 2015, developed a prospective study which enrolled 123 patients who underwent thyroid interventions with neuromonitoring and all had been treated by the same surgeon. The signal obtained from RLN localization, 215 nerves (96%), from a total of 222 , show a clear and reliable EMG response. 7 nerves (3%) were not received through EMG signal. In 3 cases involving 5 RLN there was a false negative result caused by electrode malposition and in 2 cases the RLN was injured during surgery.Clinical evolution of the procedure and more extended studies are needed to show if intraoperative monitoring decreases the rate of recurrent laryngeal nerves iatrogenic injury.