T-Y Chen*, A Kumar*
Department of Otolaryngology Head and Neck Surgery, Palmerston North Hospital, New Zealand

Thyroid and parathyroid operations are a group of procedures with a rich history. 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] RLN monitor is often utilized to identify the RLN intra-operatively to prevent its accidental damage.

Introduce the routine use of video laryngoscope as a tool to ensure correct placement of intra-laryngeal RLN monitor for safe and effective RLN monitoring intra-operatively.

We took photos to demonstrate the displacement of the intra laryngeal monitor after patient positioning.

We introduced the routine use of video laryngoscope after the positioning of patient for thyroid operation. After introduction we have found significant number of displaced intra-laryngeal electrodes from positioning alone. With the identification of incorrectly displaced electrodes, we also had no further failed RLN monitoring.

RLN monitor is highly sensitive and specific and comes in both intra and extra laryngeal electrodes.[2] However, its correct functioning is highly dependable on the correct positioning of the electrodes to complete the circuit. Thyroid operation entails the need for neck extension and this often displaces the electrodes distally leading to failure of the device. We have devised a simple technique to correct the placement pre-operatively making it safer and simpler intraoperatively.

[1] Miller MC, Spiegel JR. Identification and Monitoring of the Recurrent Laryngeal Nerve During Thyroidectomy. Surg Oncol Clin N Am 2008;17:121–44.

[2] Bailleux S, Bozec A, Castillo L, Santini J. Thyroid surgery and recurrent laryngeal nerve monitoring. J Laryngol Otol 2006;120:566–9