Nerve Monitoring in Remote Access Thyroid Surgery

Ever since its modern introduction in the early 1990s, intraoperative monitoring of the recurrent laryngeal nerve has become an important facet of thyroid surgery. An increasingly large number of thyroid surgeons utilize this technology to improve identification of the nerve, preserve the nerve during the operation, and ensure nerve integrity after dissection is complete. This technique can be utilized with both open and remote access approaches. A more recent development in nerve monitoring is the use of somatosensory evoked potentials to monitor the brachial plexus during the trans-axillary surgical approach. This chapter reviews nerve monitoring in remote access thyroid surgery with particular attention paid to somatosensory evoked potentials to protect the brachial plexus during trans-axillary thyroid surgery. In order to use the nerve monitoring system to its full potential, the surgeon must be familiar with the basic terms and concepts that are the foundation for the system, as well as the benefits and risks of its use.