Low Risk of Vagal Nerve Injury With Continuous Neuromonitoring Technique in Thyroidectomy

Background: Continuous intraoperative neuromonitoring (CIONM) requires deliberate vagus nerve (VN) dissection and circumferential electrode placement, introducing an iatrogenic injury risk not traditionally encountered in standard thyroidectomy. Objective: To characterize the patterns, mechanisms, and outcomes of VN injury associated with CIONM during total thyroidectomy and to outline prevention strategies. Design: Single-institution, retrospective case series. Methods: 9 patients with postoperative VN injury were identified from a prospective database of 1060 consecutive thyroidectomies performed with neuromonitoring from 2014 to 2024. Variables included patient characteristics, surgery characteristics, monitoring data, and recovery to 180 days. Results: Among 1060 thyroidectomies, VN injury occurred in 9 of 2120 nerves at risk (0.42%). Overall, 8 injuries were transient, resolving clinically at a mean of 131 ± 47 days, and 1 was permanent. The majority (89%) arose during in more...