Neuromonitoring in Thyroid Surgery

Over the years, the thyroid surgery has evolved into a sophisticated operation with attention to reduce morbidity related to thyroid surgery. Recurrent laryngeal nerve (RLN) injury is the most feared complication of thyroid surgery and it directly impacts patient’s postoperative voice outcome. We recognize that a structurally intact nerve does not essentially equate a functional nerve. While visualization of the RLN during surgery remains the gold standard and sound anatomical knowledge and experience are important tools, intraoperative neuromonitoring (IONM) is now emerging as a valuable adjunct in preventing RLN injury during surgery of the thyroid and parathyroid glands. This chapter presents an overview of IONM with the standards of RLN monitoring techniques, and its applications particularly, in surgical decision-making during thyroid surgery as well as recent advances in the technique.