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Priya et al. J Cancer Metastasis Treat 2021;7:70 Journal of Cancer
DOI: 10.20517/2394-4722.2021.122
Metastasis and Treatment

Review Open Access

Intraoperative monitoring of the recurrent laryngeal
nerve in surgeries for thyroid cancer: a review

1,2
3
SR Priya , Srinjeeta Garg , Mitali Dandekar 3
1
Head Neck Surgery, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam 530053, India.
2
Head Neck Surgical Oncology, Tata Memorial Centre, Mumbai 400012, India.
3
Head Neck Surgical Oncology, Paras Cancer Centre, Patna 800014, India.
Correspondence to: Dr. Mitali Dandekar, Head Neck Surgical Oncology, Paras Cancer Centre, Paras HMRI Hospital, Bailey Road,
Patna 800014, India. E-mail: mitalidandekar@gmail.com
How to cite this article: Priya S, Garg S, Dandekar M. Intraoperative monitoring of the recurrent laryngeal nerve in surgeries for
thyroid cancer: a review. J Cancer Metastasis Treat 2021;7:70. https://dx.doi.org/10.20517/2394-4722.2021.122

Received: 24 May 2021 First Decision: 19 Jul 2021 Revised: 26 Jul 2021 Accepted: 4 Aug 2021 Published: 17 Dec 2021
Academic Editors: Lucio Miele, Jerome M. Hershman Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Intraoperative nerve monitoring (IONM) has evolved into an objective tool not only for the identification but also
for the preservation and prognostication of function of the recurrent laryngeal nerve in thyroid surgeries. Technical
improvements have resulted in the increasing incorporation of IONM into operating rooms around the world. The
importance of adherence to recommended standards is also recognized as being vital in optimizing the efficacy of
IONM. The advent of continuous IONM has made real-time nerve monitoring possible, thus providing the surgeon
with an ally in difficult surgeries. Additionally, as thyroid surgeries are evolving into remote access and minimally
invasive procedures, so also is the applicability of IONM. This review focuses on the use of IONM for nerve
monitoring in thyroidectomies for neoplastic conditions while discussing the rationale, technique, and
interpretation of findings and their implications.

Keywords: Intraoperative nerve monitoring, thyroidectomy, recurrent laryngeal nerve, electromyography, vagus
nerve

INTRODUCTION
The incidence of total thyroidectomies performed for thyroid cancers in major centers across the globe has
increased over the years, thus increasing the number of recurrent laryngeal nerves (RLN) at risk . Injury to
[1]

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
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