Intraoperative neuromonitoring during endocrine surgery

Recurrent laryngeal nerve (RLN) injury is a known complication of thyroid surgery. Patients undergoing reoperations or extensive resections of malignancies carry an increased risk of nerve damage. The gold standard for preventing RLN injury is identification of the RLN. The development of a new technique has enabled intraoperative testing of RLN function. Intraoperative neuromonitoring has an excellent specificity and negative predictive value in which an unchanged positive signal is highly predictive of intact nerve function. This technique facilitates RLN identification in altered anatomy as is found at reoperation and can prevent bilateral vocal cord palsy. Additionally the prognosis of patients with postoperative voice symptoms can be supported by the objective intraoperative measurements.