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Thyroid Biology and Disease

SUN-395 - Intraoperative Recurrent Laryngeal Nerve Monitoring in Pediatric Thyroid Surgery: A Systematic Review and Meta-analysis

Sunday, June 14, 2026
9:00 AM - 4:00 PM CT


Background:
Pediatric thyroid disease requiring surgery carries a risk of recurrent laryngeal nerve (RLN) injury, a major source of morbidity. Although intraoperative nerve monitoring (IONM) is widely used, its benefit in children remains uncertain. We compared IONM with visual nerve identification alone for preventing RLN injury in pediatric thyroidectomy.

Methods:
PubMed/MEDLINE, Cochrane, Scopus, Web of Science, EMBASE, CINAHL, CNKI, and LILACS were searched through January 2026. Studies including patients ≤18 years undergoing thyroidectomy with and without IONM were included. The primary outcome was postoperative RLN palsy. Random-effects meta-analysis was performed.

Results:
Five retrospective cohort studies (369 patients) were included; four entered meta-analysis. In per-patient analysis (138 patients, 10 events), IONM was not associated with a significant reduction in RLN palsy (RR 0.46; 95% CI 0.00–414.90; p=0.39; I²=0%). Findings were similar in per-nerve analysis (435 nerves, 23 events; RR 0.40; 95% CI 0.08–2.01; p=0.14; I²=0%).

Conclusion:
IONM was not associated with a statistically significant reduction in RLN injury in pediatric thyroid surgery. These findings highlight limited and imprecise evidence and underscore the need for adequately powered prospective studies to inform perioperative management in pediatric thyroid disease.

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