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As a risk minimization tool, intraoperative nerve monitoring (IONM) has been introduced to verify RLN function integrity intraoperatively. Nevertheless, a systematic evidence\u2010based assessment of this novel health technology has not been performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The present study was based on a systematic appraisal of the literature using evidence\u2010based criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Recurrent laryngeal nerve palsy rates (RLNPR) varied widely after thyroid surgery, ranging from 0%\u20137.1% for transient RLN palsy to 0%\u201311% for permanent RLN palsy. These rates did not differ much from those reported for visual nerve identification without the use of IONM. Six studies with more than 100\u00a0nerves at risk (NAR) each evaluated RLNPR by contrasting IONM with visual nerve identification only. Recuurent laryngeal nerve palsy rates tended to be lower with IONM than without it, but this difference was not statistically significant. Six additional studies compared IONM findings with their corresponding postoperative laryngoscopic results. Those studies revealed high negative predictive values (NPV; 92%\u2013100%), but relatively low and variable positive predictive values (PPV; 10%\u201390%) for IONM, limiting its utility for intraoperative RLN management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Apart from navigating the surgeon through challenging anatomies, IONM may lend itself as a routine adjunct to the gold standard of visual nerve identification. To further reduce the number of false negative IONM signals, the causes underlying its relatively low PPV require additional clarification.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-008-9483-2","type":"journal-article","created":{"date-parts":[[2008,2,29]],"date-time":"2008-02-29T16:41:50Z","timestamp":1204303310000},"page":"1358-1366","source":"Crossref","is-referenced-by-count":413,"title":["Intraoperative Monitoring of the Recurrent Laryngeal Nerve in Thyroid Surgery"],"prefix":"10.1002","volume":"32","author":[{"given":"H.","family":"Dralle","sequence":"first","affiliation":[{"name":"Department of General, Visceral and Vascular Surgery Martin\u2010Luther\u2010University of Halle Ernst\u2010Grube\u2010Str. 40 D\u201006097 Halle\/Saale Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Sekulla","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Vascular Surgery Martin\u2010Luther\u2010University of Halle Ernst\u2010Grube\u2010Str. 40 D\u201006097 Halle\/Saale Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Lorenz","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Vascular Surgery Martin\u2010Luther\u2010University of Halle Ernst\u2010Grube\u2010Str. 40 D\u201006097 Halle\/Saale Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Brauckhoff","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Vascular Surgery Martin\u2010Luther\u2010University of Halle Ernst\u2010Grube\u2010Str. 40 D\u201006097 Halle\/Saale Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Machens","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Vascular Surgery Martin\u2010Luther\u2010University of Halle Ernst\u2010Grube\u2010Str. 40 D\u201006097 Halle\/Saale Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the German IONM Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2008,2,28]]},"reference":[{"key":"e_1_2_7_2_2","first-page":"1167","article-title":"Medicolegal analysis of errors in diagnosis and treatment of surgical endocrine disease","volume":"114","author":"Kern KA","year":"1993","journal-title":"Surgery"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s001040050875"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0892\u20101997(98)80042\u20108"},{"key":"e_1_2_7_5_2","first-page":"223","article-title":"Effect of voice disorders on quality of life","volume":"4","author":"Smith E","year":"1996","journal-title":"J Med Speech Language Pathol"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365\u20102168.1999.01017.x"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2004.07.018"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199809000\u201000005"},{"key":"e_1_2_7_9_2","first-page":"775","article-title":"Routine dissection and demonstration of the recurrent laryngeal nerve in subtotal thyroidectomy","volume":"66","author":"Lahey FH","year":"1938","journal-title":"Surg Gynecol Obstet"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(56)92333\u20109"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010200202000\u201000015"},{"key":"e_1_2_7_12_2","first-page":"139","article-title":"Recurrent nerve palsy after thyroid operations\u07ddprincipal nerve identification and a literature review","volume":"115","author":"Jatzko GR","year":"1994","journal-title":"Surgery"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6060(99)70121-2"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005537\u2010200201000\u201000022"},{"key":"e_1_2_7_15_2","unstructured":"British Thyroid Association\u2010BTAGuideline for the management of Thyroid Cancer in Adults. 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