Abstract: Objective To compare the difference between intraoperative nerve monitoring (IONM) and conventional visualization on identifying and protecting recurrent laryngeal nerve (RLN) during parathyroidectomy and discuss the application value of IONM in parathyroidectomy. Methods Clinical data about 37 patients who had single parathyroid adenoma and underwent parathyroidectomy from January 2014 to April 2016 in the department of general surgery of Chinese PLA General Hospital were analyzed. IONM was used in 23 patients in IONM group and conventional exposure was applied in 14 patients in non-IONM group. The operating time, RLN identification time, intraoperative bleeding volume, postoperative drainage volume, injury rates of RLN were compared between two groups. Results There were significant differences in the average operating time, RLN identification time, intraoperative bleeding volumes and postoperative drainage volume between non-IONM group and IONM group(57.3±11.3) min vs (47.9± 10.6) min, (15.9±2.2) min vs (9.7±2.1) min, (24.0±11.6) ml vs (15.3±6.9) ml, (43.9±11.9) ml vs (35.1±9.2)ml, P< 0.05. The RLN temporary injury rates were 14.3% and 4.3% respectively and the permanent injury rates in both groups were 0. Conclusion IONM can identify and locate RLN quickly, shorten the operating time, avoid unnecessary tissue damage and enhance the safety of operating, which is worthy of promoting in parathyroidectomy.