Nerve Monitoring for Transoral Thyroid Surgery: Why, How, and What to Expect

Purpose of Review: We primarily describe technical tips, and attempt to demonstrate the value of using intermitted neural monitoring (IONM) during transoral endoscopic thyroidectomy vestibular approach (TOETVA), with emphasis and respect given to nerve monitoring standards described by the International Neural Monitoring Study Group (INMSG). Recent Findings: Any modifications to the established operative technique for TOETVA should result in similar or improved patient outcomes with lower rates of complications. TOETVA is a new technique that demands full protection of RLN function during the cranial to caudal thyroid and RLN dissection. Standardized IONM is feasible and safe in TOETVA. IONM is complementary to the video-endoscopic identification of the RLN. Summary: The role of IONM in transoral thyroid surgery continues to be defined. It may be that as one starts performing this surgery, intermittent IONM may provide value in confirming and preserving the neurophysiologic integrity of the RLN. Further studies are needed to evaluate this.