Precision and protection: advancements and future of neuromonitoring techniques for laryngeal surgery

Intraoperative neuromonitoring (IONM) has improved the safety of laryngeal surgeries by protecting critical nerves such as the recurrent laryngeal nerve and vagus nerve. This review traces the evolution of neuromonitoring from its late 19th-century origins to the modern era, focusing on the transition from intermittent intraoperative neuromonitoring (I-IONM) to continuous intraoperative neuromonitoring (cIONM). Unlike I-IONM, which offers periodic nerve activity snapshots, cIONM provides continuous, real-time feedback throughout surgery, improving nerve injury detection and prevention. Advances in electromyography (EMG) techniques and the laryngeal adductor reflex have been key in this progression. The integration of endotracheal tube-based systems has revolutionized monitoring by providing less invasive and more accurate assessments. The review also explores cIONM's role in minimally invasive surgeries, such as robotic and endoscopic procedures, offering enhanced precision and better patient outcomes. It further discusses recent advancements in EMG techniques and future directions, highlighting the potential for innovations to enhance the precision and safety of laryngeal surgeries.