Improving Safety of Neural Monitoring in Thyroid Surgery: Educational Considerations in Learning New Procedure

Literature on intraoperative neuro monitoring (IONM) during endocrine surgery have increased over
recent years. A comprehensive understanding of the role of IONM for prevention of nerve injuries is
critical to maximize safety during surgery of the anterior compartment of the neck. Neuromonitoring
techniques are currently considered safe technique and technology; however, albeit sporadically, have
been reported some complications and related side effects using such methods. The complications
described can be related to the electrodes positioned at the larynx, at the obstruction of the endotracheal
tube, the drugs used for anesthesia and the effects of electrical stimulation on nerve structures and
systemic levels. This review will explore the safety issues of IONM to improve the outcomes among
patients undergoing monitored thyroidectomy.