Use of Intraoperative Neuromonitoring in Thyroid Surgery in Poland - Current Status and Prospects for Development

<b>Introduction:</b> Thyroid surgery carries the risk of injury to the recurrent laryngeal nerve (RLN) and the external branch of thesuperior laryngeal nerve (EBSLN), which can result in postoperative phonation disorders and reduced quality of life. Overthe last two decades, the technique of intraoperative neuromonitoring (IONM) of laryngeal nerves has become increasinglywidespread, both in Poland and globally.<b>Aim:</b> To evaluate the implementation and use of IONM during thyroid surgeries in Poland.<b>Methods and materials:</b> A personal survey (37 questions) concerning the use of IONM in thyroid surgery was analyzed. The survey was prepared by the Neuromonitoring Research Group under the auspices of the Polish Endocrine Surgery Club. It was distributed to 160 surgical centers where thyroid surgeries with IONM are performed. A total of 80 surveys (50%) were returned, constituting the study group.<b>Results:</b> IONM is routinely used for RLN identification (100%), while EBSLN is monitored in 16.2% of cases. Intermittentneuromonitoring (i-IONM) predominates (72.5%) over continuous neuromonitoring (c-IONM) (7.5%). The main indicationsfor thyroid surgery with IONM are: reoperations for thyroid cancer (97%), recurrent goiter (95%), thyroid cancer with clinicaladvancement greater than cT1aN0 (94%), Graves' disease (82%), and retrosternal goiter (77%). Staged surgery following lossof signal on the first operated side was performed in 38.7% of thyroid cancer cases and 58.8% in benign goiter cases. Theprimary limitation to the widespread use of IONM in Poland is the increased cost of surgery (55%); 83.3% of respondentsbelieve that further development of this technique in Poland requires the establishment of Polish guidelines for its use.<b>Conclusions:</b> Improving the safety of thyroid surgeries in Poland with IONM requires routine training and the dissemination of guidelines on the standardized use of this method in daily practice. Additionally, there is a need to improve the cost reimbursement for thyroid surgeries, considering the rising costs of IONM.