Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach Part 2

One of the most feared complications in thyroid surgery is injury to the superior laryngeal nerve or recurrent laryngeal nerve. Neuralidentification during surgery is insufficient to assess nerve injury. Intraoperative nerve monitoring of the vagal nerve and recurrent laryngealnerve during thyroid surgery is a new adjunct designed to allow better identification of nerves at risk and therefore reduce complicationsrelated to their injury. This new working tool does not substitute adequate surgical technique but merely provides the surgeon with anadjunct to routine visual identification and functional assessment. The use of nerve monitoring requires standardization of the monitoringprocedure. Pursuant to this, we will discuss in two related articles the current state of the art standardized technique of nerve monitoring inthyroid surgery. The aim of part 1 is to provide a concise overview of nerve monitoring in thyroid surgery and its effectiveness. This willinclude a brief review of the surgical anatomy of the recurrent laryngeal nerve and the key landmarks used to identify the nerve duringsurgery. Part 2 will describe how to perform the standardized nerve monitoring in a step by step fashion during thyroid surgery which willdiminish variable results and misleading information associated with a nonstandardized nerve monitoring procedure.

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