Future Directions of Neural Monitoring in Thyroid Surgery

Dissecting and identifying the recurrent laryngeal nerve (RLN) are considered routine procedures now that safe and effective methods have been established. Preventing RLN injury during thyroid surgery requires good visualization and exposure of the RLN, adequate knowledge of RLN anatomy, adequate surgical experience and training, and pre- and post-operative laryngoscopy. Whereas these requirements are widely accepted for routine thyroid surgery, new technical developments have emerged in the past 15 years. Literature show that both intermittent intraoperative neural monitoring (I-IONM) and continuous IONM (C-IONM) are recognized as effective techniques for RLN. The aim of this paper is to discuss advantages, limits and possible future directions for use of IONM and C-IONM in thyroid and parathyroid surgery.