A Randomized Controlled Trial of Intraoperative Nerve Monitoring in Resident-Performed Thyroidectomy

Abstract

Objective: Intraoperative nerve monitoring (IONM) is widely used in thyroidectomy to aid recurrent laryngeal nerve (RLN) identification and preservation. This study assessed whether IONM improves RLN identification time and overall operative time in less experienced otorhinolaryngology residents performing thyroidectomies. Methods: This randomized controlled trial was conducted at Siriraj Hospital, Bangkok, from January 2020 to February 2021. A total of 80 patients were randomly assigned to an IONM or non-IONM group. A total of 10 residents performed eight thyroidectomies each, using IONM in four procedures and non-IONM methods in the other four. Results: RLN identification was significantly quicker in the IONM group (6.7 vs. 19.7 min for primary identification, 11.0 vs. 19.7 min for visual identification). IONM increased setup and nerve dissection time but without significant differences in overall operative time or RLN injury rates. Conclusions: IONM improves RLN identification efficiency in surgical training but does not significantly impact overall operative time or RLN injury rates. Level of Evidence: 2. Trial Registration: Clinical Trials Registry (TCTR20191224001).