In recent years video-assisted thyroidectomy (VAT) has become a valid option for the treatment of small thyroid nodules. Eligibility criteria are: small thyroid nodules (< 35 cm) in small or normal thyroid gland (thyroid volume 20 ml), no previous neck surgery or irradiation. More than three hundred and fifty VAT procedures have been performed in our centre through six years of experience. Recently the Recurrent Laryngeal Nerve (RLN) monitoring has been reported to have a role in reducing the incidence of dysphonia and recurrent nerve palsy after conventional thyroidectomy. In this video we describe our initial experience with RLN Monitoring during VAT.

VAT is performed as usually, through a single 1.5-2.0 cm horizontal central skin incision between the cricoid cartilage and the sternal notch, A 5 mm 30° endoscope is used for vision.

For nerve stimulation a surface endotracheal tube-based electrode system is used (NIM 2 EMG endotracheal tube). Endotracheal tube electrodes and grounds are interfaced with a monitor oscilloscope through a connector box. The monitor has a pulse generator to which is connected a sterile, stimulating hand-held electrode. The Nerve stimulator is placed on the nerve with a subsequent wide deformation of the baseline that represent the EMG activity. The RLN stimulation has been used to confirm the identification of the nerve during dissection and to check the integrity of the nerve at the end of the surgical procedure.

No complication occurred. Final histology showed a benign toxic goitre. The patient was completely satisfied with the cosmetic result, the procedure and the surgical outcome. RLN monitoring confirmed to be a useful adjunct for thyroid surgery, also during video-assisted procedures. We are optimistic about the future of this approach even if comparative series are necessary to assess the advantages of this RLN Monitoring during Video-assisted thyroidectomy.