With the advance of continuous intraoperative neural monitoring (C-IONM), surgeons pay more attention to the distributing characteristics and operating approaches of vagus nerve (VN) in thyroid surgery. According to the adjacent relations with common carotid artery and internal jugular vein, the distributing location of VN can be divided into 4 types. And type P, among them, accounts for 73%. Three surgical approaches are applied in carotid sheath exposure. In order to place the probe of C-IONM, carotid sheath sharply dissection and a 10 to 15 mm long "pocket" would be performed before 360° separating the VN. Along with the clear recognition of VN anatomical distribution, the operation of VN place and remove would be more and more secure in thyroid surgeries. C-IONM is helpful in identifying the injury of laryngeal recurrent nerve and making surgical decisions. So it might gain wider acceptance in the near future.