In recent years, the incidence of thyroid disease has been increasing, and more and more patients are requiring surgical treatment. In clinical practice, we often encounter the following cases: large thyroid tumors requiring subtotal or total thyroidectomy; thyroid cancer requiring cervical lymph node dissection; nodular goiter or thyroid cancer recurring after surgery requiring secondary surgery; patients with conventional pathology of thyroid cancer due to lack of rapid pathology in the first operation in some primary care hospitals, and the scope of surgery is insufficient for secondary surgery …. In these cases, especially in the second or multiple surgeries, the tissue adhesions and unclear structures can easily lead to laryngeal nerve injury. It is one of the most serious complications of thyroid surgery. Patients may experience hoarseness, reduced volume or loss of voice, and in the case of bilateral laryngeal nerve injury, the gap between the vocal cords is reduced bilaterally, which may affect breathing in severe cases. Therefore monitoring and protection of the recurrent laryngeal nerve should be considered as an important step in thyroid surgery. The monitoring and protection of the recurrent laryngeal nerve has roughly three stages in history: years ago, thyroid surgery was performed with cervical plexus anesthesia and patients were kept awake during surgery. When the surgeon suspected that the tissue was the recurrent laryngeal nerve, he or she relied on asking the patient about his or her articulation to avoid damage to the nerve. However, patients are often nervous and their heart rate, blood pressure and respiration are unstable, and this method has now been abandoned in our hospital. The second stage is to expose and protect the recurrent laryngeal nerve. During subtotal or total thyroidectomy, the physician takes the initiative to expose and protect the recurrent laryngeal nerve. Many physicians are unable to master this technique and are overly concerned about the occurrence of injury to the laryngeal nerve and perform local excision of nodules or masses, which reduces the scope of surgery too much and increases the recurrence rate. The third stage is the application of real-time laryngeal electromyography monitoring technology, i.e., the application of the recurrent laryngeal nerve monitor. By electrically stimulating the recurrent laryngeal nerve, laryngeal electromyography is induced through the electrodes in contact with the vocal cords, and the waveform is displayed on the screen and the electromyography is output in the form of sound at the same time. We have performed more than 30 surgeries using this technique, most of which are difficult thyroid re-operations. The operation time is significantly shortened, and the nerve can be located more easily during the operation, avoiding damage to the nerve during the operation. The application of the nerve monitor reflects the purpose of “two good and one satisfactory” at this stage, which can benefit the patients and protect our surgeons and reduce the occurrence of medical disputes.