Systematic Use of Recurrent Laryngeal Nerve Neuromonitoring Changes the Operative Strategy in Planned Bilateral Thyroidectomy

Background: One of the worst complications in thyroid surgery is bilateral recurrent laryngeal nerve paralysis, which can lead to transient or definitive tracheotomy. Methods: We implemented a strict standard operative procedure beginning in January 2010 and modified our operative procedure. In all patients undergoing bilateral operation, we begin with the largest side or with the cancerous/suspicious side without dissecting the contralateral side. If the intraoperative neuromonitoring (IONM) signal is lost after stimulation of the vagus nerve at the end of the first side, we stop the procedure after the unilateral lobectomy, even if the recurrent nerve is anatomically intact and regardless of malignancy. If the IONM signal is lost, serial laryngoscopies are performed until recovery or definitive recurrent laryngeal nerve palsy is demonstrated. We report here our results in patients with loss of the IONM signal after lobectomy and discuss the medical implications for benign and malignant thyroid condition...