Intermittent neural monitoring of the recurrent laryngeal nerve in surgery for recurrent goiter

Reoperative thyroid surgery is relatively rare, but still represents a major challenge, even for skilled surgeons, because of the higher incidence of complications than in primary thyroid operations, in particular hypoparathyroidism and injury to the recurrent laryngeal nerve (RLN). The RLN is at high risk during reoperations, due to the likelihood of displacement and scarring following previous neck surgery. The prevalence of RLN injury during reoperative thyroid surgery is as high as 12.5% for transient injury and up to 3.8% for permanent injury, which is a serious complication influencing the quality of life and having a wide range of symptoms (1-15) (Table 1)