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J Vis Surg. 2018 Jan 26;4:24. doi: 10.21037/jovs.2017.12.25. eCollection 2018.

Monitored transoral endoscopic thyroidectomy via long monopolar stimulation probe.

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Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood ''G. Barresi'', University Hospital G. Martino, University of Messina, Messina, Italy.
Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Minimally Invasive and Endocrine Division, Department of Surgery, Police General Hospital, Bangkok, Thailand.
Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, China Japan Union Hospital of Jilin University, Changchun 130033, China.
Department of Surgery, S. Anna University Hospital, Ferrara, Italy.
Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy.


This video aimed to describe the role of intraoperative neuromonitoring (IONM) during transoral endoscopic thyroidectomy vestibular approach (TOETVA) with emphasis given to IONM technical and technological notes, the identification of recurrent laryngeal nerve (RLN). Standardized technique of IONM consist in identifying and monitoring both the vagus nerve and the RLNs before and after resection (V1, V2, R1, R2). According to this report, IONM during TOETVA is feasible and safe in providing identification and function of laryngeal nerves. IONM enable surgeons to feel more comfortable with their initial approach to TOETVA or extended indications. Larger series are needed for appropriated evaluation of IONM in reduction of the rates for RLN complications.


Thyroid; intraoperative neural monitoring; mini-invasive thyroidectomy; standardization; thyroidectomy; transoral thyroidectomy

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

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