AIM: In the present study the Authors assess the advantages of new technologies in thyroid surgery: to prevent nerve injury by using an intra-operative continuous nerve-monitoring techniques and to compare the real advantages of advanced coagulation devices MATERIALS AND METHODS: Among a series of 440 thyroidectomies (jan 2004-feb 2006) the Authors reviewed charts from two groups: 1) 240 total thyroidectomies performed using the traditional monopolar electrocautery, non-absorbable stitches for the principal vascular pedicles. 2) 140 total thyroidectomies performed using dedicated small bipolar electro thermal coagulator (Ligasure-Precise®). 3) Since 2006 in a double blind group selection of 70, we’ve performed Sutureless Thyroidectomy with continuous intraoperative nerve monitoring using dedicated endotracheal tube. Mean operative time, post-operative bleeding, post-operative stay, incidence of transient or definitive laryngeal nerve lesions, incidence of permanent or transient hypocalcaemia, costs of the procedures were analyzed RESULTS: Major complications in the first two groups compared with the data of the literature are absolutely over-imposable, except a reduction of incidence of transient hypocalcaemia in the Precise group, but if we compare data of the 3rd group (NIM), we find a significative reduction of transient and permanent laryngeal nerve palsy incidence. DISCUSSION AND CONCLUSION: This new technology offers several advantages: (1) atraumatic; (2) easy to use; (3) continuous monitoring and audio feedback to the surgeon (4) works outside the operation field (5) high sensitiveness. Costanalysis confirm that NIM + Ligasure have same or less cost and time and probably less complications than traditional Total Thyroidectomy