| Objective: The purpose of this meta-analysis study was to evaluate the protective value of recurrent laryngeal nerve(RLN)injury with intraoperative neuromonitoring(IONM)technique versus RLN visual identification alone during thyroid cancer surgery.Methods: Literature search was performed in the following electronic databases:PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang Database and Weipu Network from the establishment of the database to 2021-January in Chinese and English.Our review collected clinical studies on IONM versus RLN exposure for thyroid cancer surgery.Rate of RLN injury was presented in terms of number of nerves-at-risk and the number of RLN injuries.All data were analyzed using Review Manger(version 5.3)and stata(version15.1)software.Results: 7 studies in English and 10 studies in Chinese including 6068 recurrent laryngeal nerves at-risk were met the inclusion criteria in this study.Our results presented that:(1)the recognition rate of RLN in the IONM group was higher than that in the exposed group,and the difference was statistically significant(P < 0.05);(2)The overall RLN injury rate and temporary RLN injury rate in the IONM group were significantly lower than those in the exposure group(P < 0.05).However,there was no significant difference in permanent RLN injury rate between the two groups(P >0.05).(3)On subgroup analysis,use of IONM decreased the overall RLN injury rate and temporary RLN injury rate in both the open surgery and endoscopic surgery(P <0.05).However,there was no significant difference in permanent RLN injury rate(P > 0.05).(4)RLN identification time,operative time,intraoperative blood loss and postoperative drainage volume in the IONM group were significantly lower than those in the exposure group(P < 0.05)and hospitalization cost in the IONM group was significantly higher than that of the exposure group(P < 0.05),but there was no significant difference in the number of retrieved central lymph nodes,duration of hospital stay and average age of patients between the two groups(P > 0.05).Conclusion:1.Compared with RLN exposure technology,the technique of IONM can improve the RLN recognition,decrease the temporary injury rate and overall injury rate of RLN in thyroid cancer surgery.Reasonable use the IONM maybe helpful in preventing RLN injury during thyroid cancer surgery.2.Compared with RLN exposure technology,the application of the technology of IONM in thyroid cancer surgery can speed up the identification time of nerves,shorter the operation time,decrease the intraoperative blood loss and postoperative drainage volume,guarantee the safety of the surgery.3.Because of the non-randomized studies included in our meta-analysis,multicenter prospective randomized controlled study with larger sample sizes is needed to further assess the role of IONM in thyroid cancer surgery. |
PDF Full Text Request