Neuromonitoring in transoral endoscopic thyroidectomy for recurrent laryngeal nerve preservation

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel scarless thyroid surgery that presents unique challenges for preserving the recurrent laryngeal nerve (RLN). Ensuring RLN integrity during TOETVA is paramount to avoid complications such as vocal cord paralysis and dysphonia. Intraoperative neuromonitoring (IONM) has emerged as an essential adjunct to optimize nerve identification and preservation in thyroid surgery. This review critically examines neuromonitoring strategies in the context of TOETVA, evaluating the use of intermittent versus continuous nerve monitoring and their integration into the transoral surgical workflow. Advances in neuromonitoring technology are also discussed, highlighting their potential to improve surgical precision and patient outcomes. Representative case studies and current evidence are synthesized to illustrate the practical benefits and limitations of IONM in TOETVA. By analyzing the existing literature and clinical practices, this review underscores the crucial role of IONM in enhancing the safety and efficacy of the transoral thyroidectomy approach while maintaining a formal, evidence-based perspective.