The protection of recurrent laryngeal nerve in thyroidectomy has been a research topic for clinicians. High-risk thyroidectomy is an operation with high rate of recurrent laryngeal nerve injury which including thyroid reoperation, giant goiter surgery, substernal goiter surgery, dorsal thyroid tumor surgey and thyroid malignancy surgery and so on. The application value of three kinds of laryngeal recurrent nerve protection techniques during high-risk thyroidectomy will be reviewed in this article, such as visualization alone, intraoperative nerve monitoring and continuous intraoperative nerve monitoring.

Recurrent laryngeal nerve (RLN) injury is a serious complication of thyroidectomy. Intraoperative neuro-monitoring(IONM) is a technology for identifying the integrity of nerves during operation by electrophysiological means, which included the intermitted IONM and the continuous IONM.This paper aims to compare the superiorities and defects of both IONM methods and summarize the current state and progress of IONM.