Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials
- PDF / 577,342 Bytes
- 15 Pages / 595.276 x 790.866 pts Page_size
- 6 Downloads / 194 Views
REVIEW ARTICLE
Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials Alvaro Sanabria • Adonis Ramirez • Luiz P. Kowalski • Carl E. Silver Ashok R. Shaha • Randall P. Owen • Carlos Sua´rez • Avi Khafif • Alessandra Rinaldo • Alfio Ferlito
•
Received: 10 April 2013 / Accepted: 2 May 2013 / Published online: 17 May 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Neuromonitoring in thyroid surgery has been employed to make nerve identification easier and decrease the rates of laryngeal nerve injuries. Several individual randomized controlled trials (RCTs) have been published, which did not identify statistical differences in the rates of recurrent laryngeal nerve (RLN) or external branch of the superior laryngeal nerve (EBSLN) injuries. The objective of this report is to perform meta-analysis of the combined results of individual studies to measure the frequency of RLN and EBSLN injuries in patients who underwent thyroidectomy with routine neuromonitoring in comparison with common practice of search and identification. RCTs comparing routine neuromonitoring versus no use in
This paper was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com).
patients who underwent elective partial or total thyroidectomy were evaluated. Outcomes measured were temporary and definitive palsy of the RLN and EBSLN. A systematic review and meta-analysis was done using random effects model. GRADE was used to classify quality of evidence. Six studies with 1,602 patients and 3,064 nerves at risk were identified. Methodological quality assessment showed high risk of bias in most items. Funnel plot did not reveal publication bias. The risk difference for temporary RLN palsy, definitive RLN palsy, temporary EBSLN palsy, and definitive EBSLN palsy were -2 % (95 % confidence interval -5.1 to 1); 0 % (-1 to 1); -9 % (-15 to -2) and -1 % (-4 to 2), respectively. Quality was rated low or very low in most outcomes due to methodological flaws. Meta-analysis did not demonstrate a statistically significant decrease in the risk of temporary or definitive RLN injury
A. Sanabria Department of Surgery, Universidad de Antioquia, Universidad de La Sabana—Oncology Unit, Hospital Pablo Tobo´n Uribe, Medellı´n, Colombia
R. P. Owen Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA
A. Ramirez Department of Surgery, Universidad Surcolombiana, Neiva, Colombia
C. Sua´rez Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
L. P. Kowalski Department Otorhinolaryngology-Head and Neck Surgery, Centro de Tratamento e Pesquisa Hospital do Cancer A.C. Camargo, Sa˜o Paulo, Brazil
C. Sua´rez Instituto Universitario de Oncologı´a del Principado de Asturias, Oviedo, Spain
C. E. Silver Departments of Surgery and Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA A. R. Shaha Head and Ne
Data Loading...
