Review Question - QID 219585

A 65-year-old female with a history of Graves disease and total thyroidectomy, and an active smoker undergoes a C5-C6 anterior cervical diskectomy and fusion for cervical radiculopathy. Her surgery was performed through a left-sided approach and was uncomplicated. In the postoperative care unit, she becomes dyspneic, and her voice is hoarse. On physical examination, she is in distress, and stridorous, with a clean, dry, and intact dressing over the left side of her neck, with no changes in her sensory nor motor examination nor palpable hematoma. A well-healed scar from a previous incision over the right anterior aspect of her neck is noted. Her drain has 5mL of bloody output. ENT is consulted and on flexible fiberoptic laryngoscopy, bilateral vocal cord paralysis is noted. Which of the following would have prevented this patient’s postoperative complication?