Despite many advances in surgical techniques during the last several decades, the risk for recurrent laryngeal nerve (RLN) injury during thyroid and parathyroid surgery has only declined, not disappeared. RLN monitoring is an attempt to reduce the risk of nerve injury during thyroid and parathyroid surgery. In this article, the author discusses how to use RLN monitoring, its effectiveness, and the options available. He also highlights potential legal and ethical issues that surround the use of this method.