Continuous monitoring of the recurrent laryngeal nerve in thyroid surgery: A critical appraisal

Gianlorenzo Dionigi, Gianluca Donatini, Luigi Boni, Stefano Rausei, Francesca Rovera, Maria Laura Tanda, Hoon Yub Kim, Feng Yu Chiang, Che Wei Wu, Alberto Mangano, Francesco Rulli, Piero F. Alesina, Renzo Dionigi

Research output: Contribution to journalReview articlepeer-review

50 Citations (Scopus)


Background and Purpose: Intraoperative neuromonitoring (IONM) contributes in several ways to recurrent laryngeal nerve (RLN) protection. Notwithstanding these advantages, surgeons must be aware that the current, intermittent, mode of IONM (I-IONM) has relevant limitations. To overcome these I-IONM limitations, a continuous IONM (C-IONM) technology has been proposed. Methods: A PubMed indexed literature review of the current limitations of I-IONM is presented and a commentary about C-IONM is provided presenting the preliminary results of research on this topic. Main findings: I-IONM, despite the advantages it produces, presents some important limitations; to overcome these drawbacks a C-IONM technology has been introduced. Conclusions: RLN traction injury is still the most common cause of RLN injury and is difficult to avoid with the application of I-IONM in thyroid surgery. C-IONM is useful to prevent the imminent traction injury by detecting progressive decreases in electromyographic amplitude combined with progressive latency increases. C-IONM seems to be a technological improvement. Likely, C-IONM by vagal nerve stimulation should enhance the standardization process, RLN intraoperative information, documentation, protection, training, and research in modern thyroid surgery. Although C-IONM is a promising technology at the cutting edge of research in thyroid surgery, we need more studies to assess in an evidence-based way all its advantages.

Original languageEnglish
Pages (from-to)S44-S46
JournalInternational Journal of Surgery
Issue numberS1
Publication statusPublished - 2013 Dec
Externally publishedYes


  • C-IONM
  • Continuous intraoperative neuromonitoring
  • IONM
  • Thyroid surgery

ASJC Scopus subject areas

  • Surgery


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