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. 2025 Sep;77(5):1563-1579.
doi: 10.1007/s13304-025-02157-6. Epub 2025 Apr 1.

Intraoperative nerve monitoring in thyroid and parathyroid surgery: a decade of Italian practice

R Melcarne  1 , G Docimo  2 , P S L Aiello  3 , S Andreani  3 , N Avenia  4 , G Basili  5 , C Bellotti  6 , D Bettini  7 , M Biffoni  8 , M Bononi  9 , A Bove  10 , P G Calò  11 , A Casaril  12 , G Cavallaro  9 , M G Chiofalo  13 , F Consorti  9 , C De Crea  14   15 , L De Pasquale  16 , P Del Rio  17 , C Dobrinja  18 , L Giacomelli  8 , G Graceffa  19 , A Gurrado  20 , M Iacobone  21 , N Innaro  22 , E Leopaldi  23 , G Lupone  24 , G Materazzi  25 , M Minuto  26 , B Mullineris  27 , N Palestini  28 , R Panconesi  29 , I Pauna  3 , A Pezzolla  20 , I P Pisano  30 , P Princi  31 , F Quaglino  32 , M Raffaelli  15   33 , L Rosato  34 , P V Sartori  35 , G Scerrino  19 , F Scolari  3 , M Testini  20 , E Traini  36 ; SIUEC IONM Collaborative Group; M Boniardi  3
Collaborators, Affiliations

Intraoperative nerve monitoring in thyroid and parathyroid surgery: a decade of Italian practice

R Melcarne et al. Updates Surg. 2025 Sep.

Abstract

Intraoperative nerve monitoring (IONM) has been recognized as a useful adjunct into the field of thyroid and parathyroid surgery, aiding in the accurate identification and preservation of the recurrent laryngeal nerve (RLN), consequently reducing the probability of nerve injury and promoting surgical safety. This investigation seeks to amplify the findings of a similar nationwide survey performed in 2014 by offering an updated assessment of IONM practices among Italian surgical institutions, reflecting a decade of advancements and transformations in clinical approaches. A comprehensive nationwide survey was implemented targeting Italian endocrine surgeons to assess the prevalence, utilization patterns, attitudes and perceptions surrounding IONM in the context of thyroid and parathyroid surgical procedures. Structured questionnaires were administered to seventy endocrine surgery centers, and the resulting data were evaluated employing both quantitative and qualitative analysis methods. The survey disclosed that 67.14% of the participants confirmed the routine deployment of IONM across all cervical surgical procedures, particularly in high-risk contexts. Relative to the findings from 2014, a marked rise in the implementation of IONM has been recorded; however, variability persists, especially between continuous and intermittent monitoring strategies. Surgeons recognized improved surgical safety, decreased complication frequencies, and educational advantages as significant key drivers for the incorporation of IONM. Nonetheless, issues, such as false-positive and false-negative results, along with the lack of standardized protocols, remain barriers to its uniform application. During the past ten years, IONM has been thoroughly adopted by Italian endocrine surgeons as a result of its critical contribution to the improvement of surgical outcomes and the provision of educational resources. However, the results highlight the imperative for further standardization of protocols, the advancement of training programs, and the resolution of reimbursement obstacles to ensure equitable and consistent application of IONM across Italian centers, ultimately optimizing patient care.

Keywords: Clinical outcomes; Nerve protection; Parathyroid surgery; Recurrent laryngeal nerve; Surgical safety; Thyroidectomy.

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