Intraoperative electromyogram monitoring of the recurrent laryngeal nerve:experience with an intralaryngeal surface electrode - A method to reduce the risk of recurrent laryngeal nerve injury during thyroid surgery

Introduction: A clinical method to localize the recurrent laryngeal nerve i ntraoperatively in order to minimize the risk of accidental injury is prese nted. Methods and results: By means of an electrode, the nerve was stimulat ed by a pulsed contact current. The resulting, muscle potential was detecte d using an electrode placed in the larynx. We applied this technique during the time period between 1 January 1997 and 31 December 1998. In 96 cases o f primary thyroid resection, the recurrent nerve was identified 167 times. The patients were operated on for nodular thyroid (n=85), Grave's disease ( n=9) and malignant papillary goiter (n=2). Retrospectively, the rate of int raoperative nerve injury, equivalent to the rate of postoperative transient and permanent nerve palsy, was 1.04% in the 96 patients and 0.60% with res pect to the 167 nerves at risk. The rate of failure of the method was 7.29% .