Intraoperative Video Laryngoscopy as Adjunct for Nerve Monitoring

The purpose of this study is to describe the impact of adding intraoperative video
laryngoscopy (IOVL) to intraoperative laryngeal nerve monitoring (IOLNM) during neck
procedures when IOLNM is routinely used, including thyroidectomy and re-operative
parathyroidectomy. Specifically, the study team seeks to assess how frequently the use of
IOVL provided confirmatory or additional information that may affect surgeon decision-making
when IOLNM alone is ambiguous, or when there is equipment malfunction or failure. The IOVL is
a disposable, otherwise standard fiberoptic laryngoscope (Larynxview, Neurovision Medical,
Ventura CA) that is inserted alongside the endotracheal tube following intubation for
surgical procedures. It allows assessment of vocal cord movement in response to nerve
stimulation. Currently, the use of IOLNM is based on audio cues, and visual assessment of
external laryngeal muscle movement during surgery in response to stimulation, but no direct
assessment of vocal cord movement is routinely possible. This information can be ambiguous
and subject to judgement of the surgeon. The addition of IOVL provides direct assessment to
vocal cord movement in response to stimulus, and may be useful in light of ambiguous IOLNM
data, or limited visualization of external laryngeal muscles.