The evolution and progress of the application of intraoperative monitoring in endoscopic thyroid surgery

Intraoperative nerve monitoring (IONM) is a validated and well accepted technology in open thyroid surgery. Intermittent and continuous neuromonitoring are the current technologies that are available. The International Neural Monitoring Group has established standards for the use of nerve monitoring in open surgery. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is becoming common in high volume endocrine surgery centers. To be widely accepted the safety benchmarks set by open surgery for neuromonitoring have to be met. The evolution of use of IONM in endoscopic thyroid surgery, the current technique of IONM use in TOETVA, equipment used, advantages and disadvantages are discussed in this review.