Intraoperative monitoring of the recurrent laryngeal nerve in thyroid gland surgery

In Thyroid surgery, the two novel approaches are the trans-axillary Robotic thyroidectomy and the trans-oral and sub-chin techniques. During these surgical approaches is mandatory to recognise the Anatomy. The lower laryngeal nerves originate from the X cranial nerve (vagus nerve) and innervate all the intrinsic muscles of the larynx except for the cricothyroid muscles (which are innervated by the superior laryngeal nerve instead). The “recurring” name is due to the course in the opposite direction to the nerve of origin. Neuro-monitoring of recurrent laryngeal nerves is the most important of the recent technological innovations. However it is of fundamental importance for the operator to remember that this method does not prevent recurrent nerve injury. On the other hand a two stage thyroidrctomy can avoid a tracheostomy thanks to neuro-monitoring.