Laryngeal nerve monitoring and minimally invasive thyroid surgery: complementary technologies.

OBJECTIVE To determine the feasibility of the combined use of laryngeal nerve monitoring and minimally invasive thyroid surgery. DESIGN Prospective, nonrandomized analysis of single-surgeon experience. SETTING Academic institution. PATIENTS Consecutive series of patients undergoing both minimally invasive thyroid surgery and laryngeal nerve monitoring. MAIN OUTCOME MEASURES Incision length and incidence of temporary or permanent laryngeal nerve injury. RESULTS Two hundred eighty-three patients underwent thyroid surgery at the Medical College of Georgia, Augusta, between January 2004 and November 2006. Some type of minimal-access approach (endoscopic or nonendoscopic) was used in 137 cases (48.4%) in which general anesthesia was administered. Laryngeal nerve monitoring was performed in 73 (53.3%) of these 137 cases, although the proportion of cases in which it was performed increased significantly from 8.7% (2 of 23 cases) in 2004 to 95.2% (58 of 61 cases) in 2006 (P < .001). There were no cases of permanent nerve injury. The incidence of temporary recurrent laryngeal nerve paresis was 4.3% (4 of 92 nerves at risk) in the cases in which laryngeal nerve monitoring was used and 6.0% (5 of 84 nerves at risk) in the cases in which the nerve was visually identified without use of a monitor. This difference failed to reach statistical significance (P = .73), which may reflect an insufficient sample size. CONCLUSION Monitoring of the laryngeal nerves is feasible in minimal-access thyroid surgery and may serve as a meaningful adjunct to the visual identification of nerves.