Clinical Validation of NerveTrend vs. NerveAssure Mode of Intraoperative Neuromonitoring in Prevention of Recurrent Laryngeal Nerve Injury During Thyroid Surgery

Objective: To compare two modes of NIM Vital application in thyroid surgery: NerveTrend TM vs. NerveAssure TM with respect to the prevalence of postoperative recurrent laryngeal nerve (RLN) injury. Background: The use of NerveTrend TM compared to intermittent neuromonitoring (i-IONM) in thyroid surgery has recently been reported to result in a tendency towards reduced RLN injury on postoperative day 1 (POD1) and a significant decrease in the need for staged thyroidectomy. However, it remains unclear whether this technique is inferior to continuous neuromonitoring (NerveAssure TM ). Methods: prospective, single-center, two-arm randomized clinical trial. The primary outcome was the prevalence of RLN injury on POD1. In the NerveTrend TM group, the surgeon-operated i-IONM stimulation probe was used for trending amplitude and latency changes from the initial vagal electromyographic baseline (at pace based on surgical judgment) to tailor the surgical strategy. In the NerveAssure TM group, it was performed using an Automatic Periodic Stimulation (APS) electrode placed on the vagus nerve. Results: A total of 264 patients were randomized into the intervention group (NerveTrend TM ) and the control group (NerveAssure TM ), 132 patients, and 264 nerves at risk (NAR), each. RLN injury was found on POD1 in 3/264 (1.14%) versus 1/264 (0.38%) NAR, whereas staged thyroidectomy was not necessary in any of the patients in the study ( P =0.624 and P =1.0, respectively). Conclusions: NerveTrend TM mode was not inferior to the NerveAssure TM mode in thyroid surgery with respect to the risk of RLN injury, and both modes had the potential to abolish the need for staged thyroidectomy.