Safety of continuous vagal neuromonitoring in thyroid surgery from gastrointestinal point of view

Continuous intraoperative neuromonitoring (c-IONM) via the vagal nerve has been recently introduced to the surgical armamentarium for thyroid surgery in order to prevent the recurrent laryngeal nerve (RLN) injury (1-4). Automatic periodic stimulation of the vagal nerve with the electric current at frequency of 0.2–2.0 Hz allows for almost real time monitoring of the functional integrity of the entire RLN during thyroid operation. When compared to the current standard of visual identification of the RLN even with use of intermittent IONM (i-IONM) allowing for improved anatomical identification of the nerve this novel concept of functional preservation is considered to be a quantum leap in nerve protection with a potential of preventing nerve injury (1).