The advent of continuous vagus stimulation (CVS), eliminating lag time between nerve preparation with potential trauma and stimulation, has transformed the intraoperative surgical strategy in thyroid surgery. Continuous intraoperative nerve monitoring empowers the surgeon to be optimally aware of traction-related injury to the recurrent laryngeal nerve (RLN). Electromyographic precursor lesions, called combined events, prompt surgeons to cease harmful surgical maneuvers and release the nerve before damage to the nerve is established. Complete RLN recovery, defined as restitution of the nerve amplitude to ≥50% of baseline, assures the surgeon that it is safe to pursue completion surgery of the contralateral side in one procedure. If this restitution is incomplete or absent (<50% of amplitude baseline) immediate vocal cord paralysis is likely and it is advisable to delay completion surgery until the nerve has fully recovered. This review summarizes the tremendous progress made in this dynamic field, delineating the extent to which CVS has changed the landscape: tailoring intraoperative decision making to determine the safest course of action for patients with benign goiter.

中文翻译：

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持续术中迷走神经刺激对良性甲状腺肿有利于或不利于双侧手术的术中决策的影响。

连续迷走神经刺激（CVS）的出现消除了潜在的创伤与刺激之间的神经准备之间的滞后时间，已经改变了甲状腺手术的术中手术策略。持续的术中神经监测使外科医生能够最佳地意识到与牵引相关的喉返神经（RLN）损伤。肌电图前体病变（称为合并事件）促使外科医生停止有害的手术操作，并在神经受到损害之前释放神经。完全RLN恢复（定义为将神经振幅恢复到基线的50％以上）可确保外科医生在一个过程中进行对侧的完全手术是安全的。如果此归还不完整或不存在（< 幅度基线的50％）可能会导致声带麻痹，建议推迟完成手术直至神经完全恢复。这篇综述总结了这一动态领域取得的巨大进展，描绘了CVS改变了现状的程度：调整术中决策来确定良性甲状腺肿患者最安全的行动方案。