Intraoperative nerve stimulation in minimally invasive thyroidectomy

Abstract

Intraoperative neural monitoring (IONM) of the recurrent laryngeal nerve (RLN) during thyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual nerve identification. IONM may be used for identification of the RLN, aid in the dissection of the RLN, and be used to anticipate postoperative neural function. This is of great significance in the prevention of bilateral nerve paralysis. In the case of nerve injury, the IONM may be used to identify the exact segment of nerve injured. The potential for reduced visual information during minimally invasive thyroid and parathyroid surgery procedure has led to the great application of neural monitoring in those cases. The use of a flexible tip of a monopolar stimulation probe allows good access to neural structures in areas outside the surgeon’s field of view. IONM in minimally invasive technique probably enables surgeons to feel more confident, indicates the correct plane of dissection, and may reduce the conversion rate to an open technique.