Objective: To compare the influence of exposure and non-exposure of recurrent laryngeal nerve (RLN) during thyroid surgery on the incidence of postoperative RLN injury. Methods: The randomized controlled trials (RCTs) comparing RLN exposure and RLN non-exposure during thyroid surgery were searched from several national and international databases. After screen for inclusion, data extraction, and quality assessment, the incidence of temporary and permanent postoperative RLN injury of the two procedures were compared by Meta-analysis. Results: Seven RCTs were finally included, with a total of 2 074 patients, of whom, 1 015 cases underwent thyroid surgery with RLN exposure (exposure group) and 1 059 cases without RLN exposure (non-exposure group). Meta-analysis results showed that either the incidence of temporary or permanent postoperative RLN injury in exposure group was lower than that in non-exposure group (OR=0.19, 95% CI=0.11–0.34; OR=0.14, 95% CI=0.06–0.34), and the differences had statistical significance (both P<0.05). Conclusion: Routine RLN exposure in thyroid surgery can effectively reduce the incidence of postoperative RLN damage. However, because no other clinical variables were compared in this study, the pros and cons of the two procedures need further verification with a large sample and high-quality RCTs.