Intraoperative monitoring of the recurrent laryngeal nerve in surgeries for thyroid cancer: a review

Intraoperative nerve monitoring (IONM) has evolved into an objective tool not only for the identification but also for the preservation and prognostication of function of the recurrent laryngeal nerve in thyroid surgeries. Technical improvements have resulted in the increasing incorporation of IONM into operating rooms around the world. The importance of adherence to recommended standards is also recognized as being vital in optimizing the efficacy of IONM. The advent of continuous IONM has made real-time nerve monitoring possible, thus providing the surgeon with an ally in difficult surgeries. Additionally, as thyroid surgeries are evolving into remote access and minimally invasive procedures, so also is the applicability of IONM. This review focuses on the use of IONM for nerve monitoring in thyroidectomies for neoplastic conditions while discussing the rationale, technique, and interpretation of findings and their implications.