WOFAPS 2025 8th World Congress of Pediatric Surgery

Kübra Öztürk Yüzdemir ¹, Tunç Tığlı ¹, Umut Ece Arslan ², Tutku Soyer ¹, Özlem Boybeyi ¹

¹ Hacettepe University Faculty of Medicine Department of Pediatric Surgery
² Hacettepe University Institute of Public Health, Department of Health Research

Aim:
Recurrent laryngeal nerve (RLN) injury and subsequent vocal cord paralysis (VCP) are significant complications of pediatric thyroid surgery. It has been suggested that intraoperative nerve monitoring (IONM) lowers the risk of nerve injury. Nevertheless, there is an ongoing discussion regarding its efficacy in preventing the nerve damage. This systematic review and meta-analysis aimed to evaluate the effect of IONM on RLN injury rates in pediatric thyroidectomy patients.

Methods:
The study protocol was drafted under PRISMA guidelines and registered on PROSPERO (CRD42025642797). A systematic literature search was conducted on PUBMED, Medline and EMBASE databases covering the period between 2000 (January) and 2024 (December). Inclusion criteria were studies reporting pediatric patients (<18 years) undergoing thyroid surgery with documented RLN monitoring and postoperative vocal cord function assessment. Data regarding the occurrence of VCP in pediatric patients who underwent thyroidectomy with or without IONM was extracted and the results were compared. Meta-analysis was performed using JAMOVI software.

Results:
Among 1183 articles, 599 abstracts were screened for inclusion criteria. Full texts of selected articles (n=42) were assessed for eligibility (n=11). The subgroup analysis was performed in 4 articles for IONM. Sub-group analysis revealed that not using IONM is associated with increased RLN injury risk, with OR of 3.27 (95% CI: 0.88–12.25, p=0.078). Kendal’s Tau test and Egger’s tests were performed revealing that there was no publication bias for all data.

Conclusions:
By systematically reviewing the literature; we found that there is no sufficient data to conclude that IONM significantly reduces the risk of nerve damage, even though it helps defining the RLN intraoperatively and may prevent nerve injury in pediatric thyroidectomy. This study also highlights the need for further high-quality prospective studies with standardized VCP assessment to confirm these findings.