Routine use or selective use of the Intraoperative neuromonitoring during thyroidectomy

Abstract

Intraoperative neuromonitoring (IONM) has become a widely utilized technique in thyroid surgery, While the routine identification of the recurrent laryngeal nerve has improved the safety of thyroidectomy, recurrent laryngeal nerve palsy remains an important complication. Some studies have shown promising results with IONM, demonstrating a lower incidence of nerve palsy compared to traditional visualization. However, the overall impact of IONM remains debated, as not all studies confirm its efficacy, especially in redo thyroid surgery. The use of IONM offers benefits in identifying and preserving the external branch of the superior laryngeal nerve, especially in cases of multinodular goiters. The decision to employ IONM should be individualized based on the surgeon's experience and the patient's clinical situation. However, its routine use is not universally supported, and its advantages may be more pronounced in specific high-risk patients and low volume surgeons.