Advances in intraoperative neuromonitoring for thyroid surgery: from electromyography tubes to sensor-based alternatives

Intraoperative neuromonitoring (IONM) plays a pivotal role in thyroid surgery, particularly for preventing recurrent laryngeal nerve (RLN) injury. While electromyography (EMG) tubes remain standard, newer sensor-based methods are emerging. To evaluate current EMG-based IONM techniques and highlight alternative approaches involving pressure and accelerometer sensors, needle electrodes, and surface monitoring, a comprehensive review of literature and comparative analysis was performed. EMG tube monitoring, though widely adopted, is susceptible to signal loss. Supplementary technologies like piezoelectric and accelerometer sensors offer improved signal stability. Needle and surface electrodes present feasible alternatives with added cost benefits and procedural flexibility. Evolving IONM modalities provide safer and more effective solutions for RLN preservation in thyroid surgery. These methods hold promise for expanding access and improving surgical outcomes.