Prevention of recurrent laryngeal nerve injury in thyroid surgery: a systematic review and meta-analysis

Objective. To evaluate the effectiveness of modern methods for preventing damage to recurrent laryngeal nerve in thyroid surgery. Material and methods. Full-text prospective comparative studies were reviewed in the PubMed Central databases, bibliographic database of the Russian Science Citation Index and Cochrane library database. Heterogeneity was assessed using forest plots, tau2 and I2 statistics. Results. Meta-analysis of pooled risk of recurrent laryngeal nerve injuries revealed significantly lower pooled estimate of the incidence of recurrent laryngeal nerve injuries in groups of intraoperative neuromonitoring (z=–2.04, p=0.0409). Heterogeneity among studies was not significant (I2=28%, p=0.25). Meta-analysis of pooled risk of damage to recurrent laryngeal nerve in case of prevention by precise dissection using ultrasound and electric cauterization found no significant differences in both groups (z= –0.19, p=0.8806). Heterogeneity among studies was moderate (I2=60%, p=0.11). There were no significant publication biases. Conclusion. Intraoperative neuromonitoring and precise dissection of recurrent laryngeal nerve using ultrasound and electric cauterization reduce surgery time. Intraoperative neuromonitoring is advisable as an optional procedure for prevention of damage to recurrent laryngeal nerve.