Prevention of Recurrent Laryngeal Nerve Injury in Thyroid Surgery: Are Neuromonitoring Techniques Needed?

Background: Identification of the recurrent laryngeal nerve is the most essential in thyroid surgery. Positive identification of the nerve is essential for preservation of nerve integrity and function. Some authors recommend using of nerve monitoring techniques. Methods: 359 thyroid surgeries with obligatory exposure of the RLN were reviewed. Meticulous dissection and exploration of the nerve was the main technique in our study. Results: The nerve was identified in 97% of cases, Temporary RLN palsy was found in 6 patients and permanent palsy was found in 1 case. No neuromonitoring techniques were used. Discussion: Our results and the literature review showed that the nerve can be clearly identified and protected in thyroid surgery without using any neuromonitoring techniques. In cases without identification, capsular dissection is the safest way to protect the nerve. Neuromonitoring techniques are time consuming, have never been a substitute to meticulous dissection and were never with better results than conventional meticulous dissection