Ethical and medicolegal issues in neuromonitoring during thyroid and parathyroid surgery: a review of the recent literature

Purpose of review Neuromonitoring of the recurrent laryngeal nerve is increasingly utilized in thyroid and parathyroid surgery. Many studies have examined this practice with respect to rates of nerve injury. We have reviewed this literature with specific focus on ethical and medicolegal issues. Recent findings The preponderance of data fail to show that neuromonitoring significantly reduces the rates of nerve injury in thyroid and parathyroid surgery. However, potential benefits can nevertheless be identified for patients in predicting nerve injuries and reducing risks of bilateral recurrent laryngeal nerve injury. The primary ethical and medicolegal issues raised by neuromonitoring relate to setting high expectations of unproven benefit and not utilizing the technology to gain the most information for patient care decision making. Summary Neuromonitoring can provide valuable information to surgeons about the functioning of the recurrent laryngeal nerve and external branch of the superior laryngeal nerve. Surgeons should follow guidelines for optimal use of neuromonitoring but should not overestimate the benefits of neuromonitoring when discussing the technology with patients.