Updates in Surgery

, Volume 69, Issue 2, pp 171–179 | Cite as

Neuromonitoring in endoscopic and robotic thyroidectomy

  • Gianlorenzo Dionigi
  • Hoon Yub KimEmail author
  • Che-Wei WuEmail author
  • Matteo Lavazza
  • Gabriele Materazzi
  • Celestino Pio Lombardi
  • Angkoon Anuwong
  • Ralph P. Tufano
Review Article
Part of the following topical collections:
  1. Endocrine surgery


Intraoperative neuromonitoring (IONM) has proven effective for intraoperative verification of RLN function in the conventional thyroid surgery. However, no studies have performed a systematic evidence-based assessment of this novel health technology in endoscopic and robotic thyroidectomy. Evidence-based criteria were used in a systematic review of relevant literature for years 2000–2015. Four electronic databases (CENTRAL, MEDLINE, Cochrane and EMBASE) were used to retrieve relevant reports published from January 1, 2000 to September 1, 2016. The search terms included “endoscopic thyroidectomy”, “robotic thyroidectomy”, “IONM”, “continuous IONM (CIONM)”, “neural monitoring”, “recurrent laryngeal nerve monitoring”, and “superior laryngeal monitoring”. The following data were retrieved from eligible studies of patients undergoing endoscopic or robotic thyroidectomy: objective of study, design and setting of study, population, intervention examined, quality of data, follow-up and dropout rate, risk of bias, and outcomes assessed. Of 160 studies retrieved, only 9 (5%) studies used IONM. Eight studies reported 522 nerve at risk (NAR) with IONM. Only three were prospective randomized studies. Reports of IONM endoscopic and robotic procedures included their use for re-surgery and use in both benign and malignant cases. None of the IONM endoscopic procedures involved bilateral palsy. Two studies reported the use of a staged strategy. The rates of recurrent laryngeal palsy were 0–3.6% for transient and 0–0.4% for permanent. Only 30% of the studies performed vagus nerve stimulation, and only 25% performed superior laryngeal nerve monitoring. In addition to the use of IONM as an assistive technology for navigating the anatomy in challenging procedures such as endoscopic and robotic thyroidectomy, IONM has potential use as a routine adjunct to the conventional video-assisted nerve identification in thyroidectomy.


Endoscopic thyroidectomy Robotic thyroidectomy Neural monitoring Recurrent laryngeal nerve 


Author contributions

(I) Conception and design of study: GD, HYK, and AA; (II) administrative support for study: GD and RPTAA; (III) collection and assembly of data: GD, HYK, and RPT; (IV) analysis and interpretation of data: GD, HYK, RPT, and AA; (V) preparation of manuscript: all authors; and (VI) final approval of manuscript: all authors.

Compliance with ethical standards

Conflicts of interest

The authors have no funding or financial relationships with manufacturers of surgical products and no other conflicts of interest in the publication of this study.

Research involving human participants and/or animals

The study was approved by the institutional ethics committee of Hospital.

Informed consent

All participants were provided the particular details for their surgeries and informed consent obtained from each patient.


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Copyright information

© Italian Society of Surgery (SIC) 2017

Authors and Affiliations

  • Gianlorenzo Dionigi
    • 1
  • Hoon Yub Kim
    • 2
    Email author
  • Che-Wei Wu
    • 3
    • 4
    Email author
  • Matteo Lavazza
    • 1
  • Gabriele Materazzi
    • 5
  • Celestino Pio Lombardi
    • 6
  • Angkoon Anuwong
    • 7
  • Ralph P. Tufano
    • 8
  1. 1.1st Division of General Surgery, Research Center for Endocrine Surgery, Department of Medicine and Surgery, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi - Polo UniversitarioUniversity of Insubria (Varese-Como)VareseItaly
  2. 2.Division of Breast and Endocrine Surgery, Department of Surgery, Anam Hospital, Minimally Invasive Surgery and Robotic Surgery CenterKUMC Thyroid Center Korea UniversitySeoulKorea
  3. 3.Faculty of Medicine, College of Medicine, Kaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan
  4. 4.Department of Otolaryngology-Head and Neck SurgeryKaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan
  5. 5.Department of Surgical Pathology, Medical, Molecular and Critical AreaUniversity of PisaPisaItaly
  6. 6.Department of Surgical Sciences, University Hospital Agostino GemelliCatholic University of Sacred HeartRomeItaly
  7. 7.Minimally Invasive and Endocrine Surgery Division, Department of SurgeryPolice General HospitalBangkokThailand
  8. 8.Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreUSA

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