Recurrent laryngeal nerve (RLN) injury is the most problematic compli­cation impacting oti the decision whether or not to perform total or completion thyroidectomy. Recurrent nerve paralysis is a less frequent complication when the nerve is rou­tinely identified. A simple technique will be described for identifying the re­current laryngeal nerve with a nerve stimulator to prevent damage to the nerve during thyroid surgery. 34 wom­en and 16 men undergoing thyroid surgery over 12 months were subject­ed to intraoperative nerve stimu-lation with increasing voltage increments by both the traditional bipolar and con­centric bipolar electrodes until both light and sound (audiosignal) indica­tors on the nerve monitor were posi­tive. All recurrent laryngeal nerves
with associated preoperative normal vocaf cord mobility were identified successfully and the location of the nerve was clearly established by the lowest stimulating current, which evoked the audiosignal response only when the probe was over the nerve, which was immediately confirmed by direct visualization. The integrity of these RLNs distal to the point of stimulation was confirmed on comple­tion of the surgery. The threshold for stimulation of the recurrent nerve varied from 0.2 to 1 milliAmpere (mA) (mean 0.37 mA) for the standard bi­polar and 0.1 to 1mA {mean 0.27 mA) for the concentric bipolar electrode. The traditional bipolar electrode threshold stimulation was consistently higher than the concentric bipolar and had less variability. Comparison between minimal stimulation levels