Application of intraoperative neromonitoring during complex thyroid operation SUN Hui,LIU Xiao-li,FU Yan-tao,et al.Division of Thyroid Surgery,China-Japan Union Hospital of Jilin University,Changchun 130033, China Corresponding author: SUN Hui,E-mail:sunhui1229@163.com Abstract Objective Apply the intraoperative neuromonitoring （IONM） as an adjunct to avoid recurrent laryngeal nerve (RLN) injury during complex thyroid operation. Methods From March 2009 to July 2009, 132 pations (186 nerves at risk) underwent complex thyroidectomy with the application of IONM. Vagus nerve and RLN were tested respectively before and after resection of thyroid lobe. Video recording of cord mobility was performed routinely pre- and postoperatively. Results In addition to 4 cases with preoperative vocal cord paralysis，182 RLN after resection of thyroid lobe with a clear electromyography(EMG) and 0％ nerves experienced signal loss before closing surgical incision showed normal electrical transduction function. Accurately detect non-RLN in 2 nerves. Conclusion IONM could make RLN identification more reliabe and precise, test the functional integrity of RLN. IONM is a useful adjunct to reduce RLN palsy rate in complex thyroid operation.