Division for Endocrine and Minimally Invasive Surgery Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina

The visual identification of the nerve is still today the standard technique in thyroid surgery. Although the systematic use of the intraoperative neuromonitoring (IONM) of the NLR has not demonstrated a statistically significant reduction in NLR lesions yet, IONM has been conclusive in the case of complex anatomy (re-operation, voluminous goiter, thyroid carcinoma) and in functional integrity of the NLR. The application of the IONM allowed to reconsider the two-phase thyroidectomy procedure in order to prevent bilateral lesions to the NLR. This method makes it possible to evaluate the possibility of proceeding safely to the completion of total thyroidectomy after resection of the dominant lobe and to decide, if necessary, to delay the resection of the second lobe at a later time, as in the case of injury or dysfunction of the NLR after lobectomy. The systematic application of IONM may lead the surgeon to modify the operative strategy in the presence of LOS from the NLR ensuring an almost zero incidence of bilateral paralysis of the NLR.It is necessary to define specific application guidelines, for the management of problems related to employment as in tumor pathology.