Intraoperative Laryngeal Nerve Monitoring During Thyroidectomy: Survey for the Current Practices and Patterns of the Korean Society of Head and Neck Surgery

Background and Objectives Intraoperative laryngeal nerve monitoring (IOLNM) is increasingly utilized during thyroidectomy to prevent recurrent laryngeal nerve (RLN) injuries. However, its use varies considerably depending on surgeon preferences and national healthcare policies, particularly insurance reimbursement criteria. This study aims to evaluate the current practices and patterns of IOLNM use among Korean head and neck surgeons.Subjects and Method A nationwide survey was conducted among 348 members of the Korean Society of Head and Neck Surgery (KSHNS). A structured 31-item questionnaire was distributed via email to assess clinical practice environments, surgeon experience, IOLNM usage patterns, indications, technical methods, management strategies for intraoperative loss of signal (LOS), anesthetic considerations, and surgeon’s perceptions regarding the utility of IOLNM.Results Fifty-nine surgeons (17.0%) completed the survey. Of these, 94.9% reported using IOLNM either routinely (32.3%) or selectively (62.7%). Selective users predominantly applied IOLNM according to health insurance criteria. Regarding procedures of IOLNM, only 10.7% adhered to all recommended international guidelines; the majority performed selected steps only (R1 and R2). Furthermore, 48.2% of respondents proceeded with planned contralateral lobectomy despite LOS. Overall, 73.2% considered IOLNM beneficial in preventing both temporary and permanent nerve injuries.Conclusion Although IOLNM is widely adopted by many Korean head and neck surgeons, routine use remains limited due to health insurance policies. To optimize IOLNM utilization, tailored guidelines reflecting national circumstances and structured educational initiatives are necessary. Further studies assessing clinical effectiveness and identifying optimal IOLNM protocols are recommended.