Clinical Report: Frequency and Influencing Factors of Recurrent Laryngeal Nerve Injury

Overview

This systematic review and meta-analysis evaluated the incidence of recurrent laryngeal nerve injury (RLNI) following thyroid surgery, analyzing data from 199 studies involving over 300,000 patients. Key findings indicate that surgical approach and intraoperative factors significantly influence the risk of both transient and permanent RLNI.

Background

Recurrent laryngeal nerve injury is a significant complication of thyroid surgery, potentially leading to severe voice impairment and decreased quality of life. Understanding the factors that contribute to RLNI is essential for improving surgical outcomes and minimizing complications. This study addresses the variability in RLNI rates and the impact of surgical techniques and patient characteristics.

Data Highlights

Key Findings

• Transient RLNI rates were highest after completion thyroidectomy (10%) and hemithyroidectomy (8%).
• Permanent RLNI was most prevalent in secondary thyroidectomy (2%).
• Transoral and transcervical surgical approaches had the highest transient RLNI rates (5%).
• Transaxillary approach had the lowest transient RLNI rate (1%).
• Meta-regression identified surgical approach, IONM use, hemostasis method, drain use, and patient age as significant risk factors for RLNI.

Clinical Implications

Surgeons should consider the type of thyroid surgery and the surgical approach when planning procedures to minimize the risk of RLNI. The use of intraoperative nerve monitoring and careful hemostasis techniques may further reduce the incidence of nerve injury. Tailoring surgical strategies based on patient characteristics is essential for improving outcomes.

Conclusion

The findings underscore the importance of surgical technique and intraoperative strategies in mitigating the risk of recurrent laryngeal nerve injury during thyroid surgery. Continued efforts to refine these approaches are necessary to enhance patient safety and quality of life.

References

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