Intraoperative Neuro-monitoring of the Laryngeal Nerves During Thyroidectomy

  • Yinin Hu
  • John B. Hanks
  • Philip W. SmithEmail author


Intraoperative neuro-monitoring allows the evaluation of laryngeal motor integrity during and following operative dissection. Within this chapter, normal and anomalous pathways of the recurrent laryngeal nerve are described, as well as the electrophysiologic principles of intraoperative neuro-monitoring. There are a number of variants of neuro-monitoring; this chapter focuses on models that use electromyographic outputs, most commonly via electrode-laden endotracheal tubes. For this technique, principles of implementation and common pitfalls are summarized.

Although there has recently been an upsurge of literature pertaining to neuro-monitoring, convincing evidence for a clinically significant benefit in thyroid surgery is lacking. Due in part to the relatively low incidence of permanent recurrent laryngeal nerve injury among experienced providers, most prospective studies on the effect of neuro-monitoring are severely underpowered. However, the utility of neuro-monitoring is not limited to nerve preservation and may include delineation of complex anatomy, operative decision-making, and surgical instruction. This chapter reviews the literature regarding intraoperative neuro-monitoring to promote thoughtful implementation of this potentially useful tool.


Intraoperative neurophysiological monitoring Thyroidectomy/adverse effects Recurrent laryngeal nerve injuries Intraoperative complications Treatment outcome Vocal cord paralysis/etiology Thyroid diseases/surgery 


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Division of General Surgery, Department of SurgeryUniversity of Virginia Health SystemCharlottesvilleUSA

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