Intraoperative neuromonitoring is used as a complement to visual identification to prevent injuries to the recurrent laryngeal nerve during thyroid surgeries. However, the data existing in the literature on its routine use and the reduction of nerve injuries are contradictory, so the aim is to quantify the usefulness of continuous vagal neuromonitoring in thyroid surgery to evaluate the convenience of its clinical application, since it involves an increased economic expense with longer surgical time.

Retrospective analytical observational study which includes 423 patients who underwent thyroid surgery between 2018 and 2023 in whom continuous vagal neuromonitoring was applied. Minors under 18 years of age and those with preoperative vocal cord motility impairment will be excluded. Nerve signal alterations are a decrease in amplitude ≥ 50% along with latency ≥ 10%. In case of suspected nerve injury, post-surgical laryngoscopy was performed. SPSS V25.0 was used for statistical analysis with p < 0.05.

Nerve signal loss was recorded in 22.5% of cases (57.7% of them with malignant pathology versus 39.1% in patients without lesion; p = 0.053). In 5.8% of patients with decreased signal, changes were made to the surgical strategy. 96.7% of them recovered nerve functionality with normal laryngoscopy in the following 12 months.

It is demonstrated that continuous vagal neuromonitoring is adequate to predict the functional status of the nerve, serving as a basis for its establishment in other centers in the country, as well as the implementation of the neurophysiologist in the hospitals where it is not used.