Prevention of Recurrent Laryngeal Nerve (RLN) palsy is still one of the biggest issues in thyroid surgery. The role of C-IONM (Continuous IntraOperative Neural Monitoring) in terms of preventing RLN palsy is still debated. Moreover, studies with large samples or based on its daily utilization are still rare, therefore C-IONM potential benefits are mostly unaddressed.

This prospective, monocentric study aimed to investigate possible differences in terms of RLN palsies (definitive and temporary) after the introduction of C-IONM on a routinery base in our surgical department when compared to the only RLN identification technique previously utilized. In order to investigate this, 729 consecutive treated patients (1103 nerves at risk) and their C-IONM reports, were analyzed on a Microsoft Excel database. The incidence of RLN palsy before and after the introduction of C-IONM was then compared.

Definitive RLN palsy with C-IONM was equal to 0,27% (3 cases), temporary RLN palsy with C-IONM over 6 months was 1,81% (20 cases). RLN definitive palsy with C-IONM was lower when compared to RLN palsy related to the RLN identification technique only, reaching statistical significance (p<0.05). Temporary RLN palsy did not statistically differ in the two surgical approaches.

⦁     C-IONM utilized on a routinary base reduces RLN definitive palsy. There is no evidence in terms of temporary palsy reduction. ⦁     The results in terms of RLN definitive palsy should encourage C-IONM utilization on a routinery base. ⦁     Further studies and randomized trials should evaluate the efficacy of C-IONM potentially as a gold standard tool in thyroid surgery.