Usefulness of Video laryngoscopy before thyroid surgery to improve nerve monitoring: A technical note

Thyroid and parathyroid operations are a group of procedures with a rich history. However, due to the high prevalence of morbidity and mortality in its history, these procedures have been often feared and marginalized in the past. Aside from the development of anaesthesia, sepsis and haemorrhage control, the recurrent laryngeal nerve (RLN) injury prevention became the next biggest advance in thyroid and parathyroid surgery. [1] Though a surgeons' sound knowledge is fundamental and irreplaceable in thyroid surgery, confirmation of the identified nerve using a nerve monitor is reassuring and often very valuable in making decisions. Lack of confirmation of signal during nerve stimulation could cause significant concern about the integrity of the nerve and in some situations even leading to limiting the operation to a hemithyroidectomy to allow clinical confirmation of vocal cord movement or performing a near total thyroidectomy to avoid injury to the contralateral recurrent laryngeal nerve. If the lack of signal was not due to nerve injury these intraoperative decisions lead to risks associated with unnecessary staged surgery or concerns over the residual thyroid tissue left behind around the contralateral RLN to protect it.

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