Continuous Intraoperative Neuromonitoring in Transaxillary Robotic Thyroidectomy: Is It Possible? A Prospective Randomized Study

Eun Jeong Ban, Cho Rok Lee, Seul Gi Lee, Min Jhi Kim, Jung Bum Choi, Taehyung Kim, Jandee Lee, Sang-Wook Kang, Jong Ju Jeong, Kee-Hyun Nam, Woong Youn Chung. Yonsei University College of Medicine


Continuous intraoperative neuromonitoring (CIONM) by vagal nerve stimulation seems to be a technological improvement. Although CIONM is a promising technology at the cutting edge of research in thyroid surgery, it still remains unclear whether IONM adds any value to the clinical outcome of transaxillary robotic thyroidectomy (RT). To the best of our knowledge, the study of standardized CIONM technique during transaxillary RT has not yet been demonstrated. The aim of this study was to assess the risk of recurrent larynageal nerve injury in transaxillary RT performed with or without CIONM.


This study was performed from May 2015 to November 2015. We prospectively evaluated 50 patients with thyroid cancer who had transaxillary RT with or without nerve monitoring. Of those patients 21 were in monitored group and 29 were in unmonitored group. Laryngoscopy and voice function test were assessed before surgery and at 2 weeks, 3 months, and 6 months after the surgery.


All procedures of CIONM during transaxillary RT were performed safely and effectively. Moreover, CIONM application was also performed safely on contralateral side even for total thyroidectomy. At first postoperative laryngoscopy, two patients (10%) in monitored group showed vocal cord palsy and 4 patients (13.9%) in unmonitored group. There was 1 loss of signal with corresponding unilateral transient vocal cord palsy. The voice function was not significantly different between the two groups. All patients with vocal cord palsy recovered completely at 3 months after surgery.


CIONM in transaxillary RT is safe and feasible to test the functional integrity of the RLN. CIONM can help to give surgeons more confidence during surgery and might be helpful for advanced training in RT.

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