Intraoperative Nerve Monitoring Setup and Data Interpretation: How Do I Augment My IONM Experience?

The purpose of this article is to review the current intraoperative nerve monitoring technologies on the market and discuss the setup and interpretation of data to provide surgeons a guide by which to perform nerve monitoring during endocrine surgical cases. The associated risk minimization to the recurrent laryngeal nerve with the use of intraoperative nerve monitoring allows continued self-improvement by surgeons during dissection and offers some protection in litigious environments. This article emphasizes the published International Neural Monitoring Study Group guidelines on intraoperative neural monitoring (IONM) during thyroid and parathyroid surgery. These guidelines have informed the algorithms by which intermittent and continuous nerve monitoring (IIONM and CIONM, respectively) is used. There have been multiple follow-up studies on rates of use, prognostication, and clinical outcomes using the technology. Established algorithms for intraoperative nerve monitoring allow the endocrine surgeon to easily gather and analyze data that are valuable in ultimately improving post-operative voice outcomes.