State of the art of neuromonitoring in thyroid surgery

Thyroidectomy is a common procedure in endocrine surgery, frequently performed to treat benign and malignant thyroid conditions. Recurrent laryngeal nerve (RLN) injury, a major complication, underscores the necessity for meticulous nerve dissection during surgery. Intraoperative neuromonitoring (IONM) has emerged as a valuable adjunct to visual identification in RLN preservation. This review synthesizes current literature on IONM in thyroid surgery, emphasizing its role in enhancing RLN integrity assessment and reducing surgical complications such as vocal cord paralysis. IONM techniques include intermittent and continuous monitoring, each offering distinct benefits in nerve function evaluation. While debate persists regarding IONM's efficacy in mitigating unilateral RLN injuries, protocols integrating IONM data have significantly reduced the incidence of bilateral RLN injury, exemplifying advancements in surgical safety. Challenges remain, including variability in study outcomes and the optimal timing of IONM application.