The pros and cons to real-time nerve monitoring during recurrent laryngeal nerve dissection: an analysis of the data from a series of thyroidectomy patients

Liu et al. published a novel and provocative article in Kaohsiung Journal of Medical Sciences entitled “Exclusive real-time monitoring during recurrent laryngeal nerve dissection in conventional monitored thyroidectomy”, that examines the benefits of intraoperative nerve monitoring during thyroidectomy with a new potential to continuously monitor the recurrent laryngeal nerve (RLN) with minimal risk. The article sheds light on the advancements in nerve monitoring as an adjunct technology to the gold standard of anatomic identification of the RLN. It demonstrates how this technology can be an aid in real-time dissection of the RLN and ultimately vocal fold function outcomes. Continuous intraoperative neuromonitoring (CIONM) of the RLN during thyroid surgery allows the surgeon to assess impending neurophysiologic injury to the nerve by measuring amplitude and latency changes which may be able to predict impending vocal fold weakness without evidence of RLN injury anatomically (1). The authors however suggest that even with the application of this technique, RLN injuries still occur. RLN injury most often occurs during dissection and goes unrecognized until postop because there is no obvious anatomic injury. Results of multiple studies suggest that the RLN is at high risk for this type of injury during dissection (1,2) and therefore continuous RLN monitoring may improve a surgeon’s vocal fold functional outcomes with more real-time, continuous monitoring.