BACKGROUND: Conventional neuromonitoring during thyroid surgery has reduced the injury rate of recurrent laryngeal nerve (RLN), but it is still at risk for damage.The feasibility of continuous RLN monitoring by vagal nerve stimulation with a new electrode system should be demonstrated in this prospective, nonrandomized experimental study.EMG signal alterations caused by stress to the RLN were analysed for imminent nerve failure.This fully implantable electrode has been used in addition to a conventional handheld bipolar stimulation electrode during thyroid surgery on 105 consecutive patients stratified to low-and high-risk groups.The signal analysis was performed as real-time audio/video feedback by the use of a new multichannel EMG system.No complications were attributable to the use of the anchor electrode.The mean delay to place the anchor electrode was 1.55 min, whereas the mean stimulation time of the vagus nerve was 42 min.Stable and repeatable signals were evocable in all cases with one exception.No permanent RLN paralyses occurred in this study.CONCLUSIONS:The vagal anchor electrode is safe and easy to use.It allows continuous neuromonitoring without any threats.The new technique will provide more security, especially during preparation steps on the RLN that are difficult for the surgeon (thyroid carcinomas, second or recurrence surgery, lymphadenectomy in central compartiment).