Transoral endoscopic thyroidectomy vestibular approach (TOETVA) offers patients scar-free surgery and is an effective therapeutic option when performed within the indications. Intraoperative nerve monitoring (IONM) is as helpful in TOETVA as in open thyroidectomy to avoid injury to the recurrent laryngeal nerve and to obtain real-time intraoperative information on nerve function. However, due to some limitations of the surgical technique, IONM can be performed effectively and reliably during TOETVA, although there are some clear differences with open thyroidectomy.