The critical identification of the recurrent laryngeal nerve (RLN) has been accepted as a safe method for gaining less vocal cord morbidity before transecting the thyroid gland (1). However, even in cases without aberrant anatomy of the RLN and in case of nerve dissection, nerve injury can occur. Additionally, in cases of central lymphn-odes' clearance, thyrotoxicosis, giant goiter, and thy-roiditis it is often hard to achieve safe nerve identification (1).Intra-operative neuromonitoring (IONM) has been proposed as an adjunct to standard visual identification and dissection of the RLN during thyroid surgery to prevent laryngeal nerve paralysis (2). The present paper reviews the relevant medical literature with a focus on reasons why IONM may improve conventional technique of thy-roidectomy. The authors believe that IONM technology may bring significant benefits in clinical practice, research, education, and medico-legal issues related to thyroid operations (Fig. 1).
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