Chinese guidelines on intraoperative neuromonitoring in thyroid and parathyroid surgery (2023 edition)

BACKGROUND: As an auxiliary tool, intraoperative neuromonitoring (IONM) has played an active role in the protection of nerve function in thyroid and parathyroid surgeries. This study aimed to help clinicians understand, standardize and reasonably apply IONM techniques in laryngeal nerves function protecting. METHODS: Hundreds of Chinese experts in the field of IONM participated in this work. All efforts have been made to ensure that these new guidelines are practical, systematic, and based on well-recognized cutting-edge evidence. Using the three previous guidelines as well as new preclinical and clinical evidence from China and other countries, the expert panel summarized the current accepted or near-accepted opinions as the recommendations. In addition, the recommendation grades and evidence levels are presented in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The first draft was completed by the writing team and then revised after several rounds of discussions via email or meetings. RESULTS: The finalized version of this guideline includes 42 recommendations, which may inform and guide our peers in their clinical practice, including all types of open, endoscopic, and robotic thyroid and parathyroid surgeries. CONCLUSIONS: This edition is currently the most comprehensive, and clinically significant guide for IONM of thyroid and parathyroid surgery in China.