Direct laryngoscopy of patients undergoing thyroid surgery should be systematically performed to assess vocal cord mobility pre and post-operative. The aim of this communication is to describe how the development of this technique has been implemented in a unit of endocrine surgery.

Retrospective observational study of patients with thyroid pathology who underwent pre- or postoperative laryngoscopy. Data regarding sex, pathology, BMI, Mallampati, exploration time, outcome, findings, complications and surgeon's experience (junior vs. senior) were analysed.

Over a 6-month period, four endocrine surgeons performed a total of 116 direct laringoscopies (72% preoperative). The most frequent diagnose were multinodular goiter (41%), followed by thyroid nodules (31%) and Graves-Basedow disease (16%). Preoperative laryngoscopies (n=83) showed pathological findings in 13% of the cases. Postoperative laryngoscopies (n=33) were abnormal in 24% of the cases, two cases showed vocal cord paralysis (6%), 4 cases paresis (12%) and 4 cases edema. The mean overall time to perform the examination was 80±63s, with juniors presenting a significantly shorter time than seniors in performing the laryngoscopies, 61±41 vs 99±70 seconds (p= 0.005). During the period under study, no complications occurred during the test. When analyzing the unsatisfactory explorations (9% of the total), no relationship was found with any of the variables studied or with the moment in the learning curve.

Direct laryngoscopy requires a learning curve to perform it safely. The learning time and time ranges have been lower in the case of junior surgeons, however, at the end of the training, the times between the two groups have been similar.