Thyroidectomy is an elective operation performed in an anatomically complex region in which certain structures are responsible for vital functions and special senses. This study aims to compare the effects of two different technical approaches-nerve dissection combined with intraoperative nerve monitoring (IONM) and no nerve identification-on recurrent laryngeal nerve (RLN) damage in total thyroidectomy. One hundred and sixty-one consecutive cases that underwent total thyroidectomy and 322 RLN under risk were evaluated. In group 1 (n=162), nerve dissection combined with IONM was performed, whereas no RLN identification was performed in group 2 (n=160). While the duration of operation in group 1 (34.23 +/- 12.21 min) was statistically shorter than that in group 2 (36.98 +/- 16.79 min, p=0.017), there was no significant difference between groups related to RLN palsy (group 1 n=10, group 2 n=7). Use of IONM was found only to shorten the duration of operation. According to our presented experience, there is no benefit of IONM-combined routine dissection of RLN during total thyroidectomy on the prevention of RLN palsy.