Intraoperative neuromonitoring during robotic thyroidectomy

Abstract

Robot-assisted thyroidectomy (RAT) offers superior cosmetic outcomes and precise surgical control, but remote approaches pose unique risks of recurrent laryngeal nerve and external branch of the superior laryngeal nerve injury. This review summarizes the role of intraoperative neuromonitoring (IONM) in RAT, focusing on stimulation protocols, endotracheal tube positioning, and continuous neuromonitoring for early traction injury detection. Literature demonstrates that IONM improves functional nerve preservation, assists surgical decision-making, and enhances safety, particularly in transaxillary and transoral approaches. IONM contributes not only to intraoperative nerve preservation but also to safer surgical learning curves and standardized decision-making in robotic thyroidectomy.