Safety of intraoperative neuromonitoring

The identification of laryngeal nerves during thyroidectomy procedures is considered the safest method to prevent variations in the motility of the vocal cords. However, the only visualization of the laryngeal nerves in many situations is not enough to ensure the result. In fact, anatomical wholeness does not always ensure the functional integrity. The number of endocrine surgery centers that use intraoperative neuromonitoring (IONM) is constantly increasing. Neuromonitoring techniques are currently considered safe methods; however, although infrequently, some complications and side effects related to the use of these methods have been reported. Recently, international guidelines on the use of IONM have been drafted and published to improve quality and safety. The aim of this work is to evaluate the safety of IONM by analyzing the complications reported in literature.