Transcutaneous Recording During Intraoperative Neuromonitoring in Thyroid Surgery

Wu, Che‐Wei; Randolph, Gregory W.; Dionigi, Gianlorenzo; Kim, Hoon Yub; Lin, Yi‐Chu; Huang, Tzu‐Yen; Lin, Chiao-I; Hun, Pao-Chu; Kamani, Dipti; Chang, Po-Chun; Lu, I‐Cheng

doi:10.1089/thy.2017.0679

Cited by 34 publications

(50 citation statements)

References 26 publications

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“…Conventional IONM using EMG endotracheal tube is troublesome and inefficient because of the necessity to confirm proper positioning, as mentioned above [35]. Several studies have reported the use of thyroid cartilage electrode EMG, transcutaneous surface electrode EMG, transcartilage surface electrode EMG by Wu et al [21,22], and PCA muscle EMG by Liddy et al [20] to overcome the disadvantages of the conventional EMG endotracheal tube [35]. However, these approaches are EMG-based IONM and cannot completely overcome the above-mentioned shortcomings of EMG.…”

Section: Discussionmentioning

confidence: 99%

“…If the dissection of the upper skin flap in humans is raised too high or the superior pole is dissected, the transcutaneous accelerometer sensor may not be in contact with the thyroid cartilage and accurate nerve monitoring may not be possible. And the transcutaneous sensor is also not suitable for surgery that requires very large incisions [22]. However, the transcutaneous sensor can be reattached if it is dislodged from the skin.…”

Section: Discussionmentioning

confidence: 99%

“…The transcutaneous sensor is considered more stable than the EMG endotracheal tube, because the anatomical relationship between the transcutaneous sensor and the vocalis muscle is not affected by the surgical manipulation [35]. The sensor should be firmly attached to the skin by Tegaderm to prevent contact failure [22]. Postcricoid EMG electrodes provide similar sensitivity to electrodes on the EMG endotracheal tube [8,37], and postcricoid EMG seems to be the best reflection of PCA muscle movement and a better reflection of the abduction movement of the vocal cords [37].…”

Section: Discussionmentioning

confidence: 99%

“…Another problem is the wide range of sensitivity and positive predictive values (PPV) of recording part to measure EMG of vocalis muscle. Several methods have been reported to overcome this problem, including the Tri-Vantage EMG endotracheal tube, subperichondrial needle electrodes, postcricoid electrodes, transcartilage electrodes, and transcutaneous electrodes [16][17][18][19][20][21][22]. However, all of these methods have problems related with the EMG method.…”

Section: Introductionmentioning

confidence: 99%

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Development of a Novel Intraoperative Neuromonitoring System Using an Accelerometer Sensor in Thyroid Surgery: A Porcine Model Study

Sung

Lee

Shin

et al. 2019

Clin Exp Otorhinolaryngol

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Objectives. The sensitivity and positive predictive value of widely used intraoperative neuromonitoring (IONM) using electromyography (EMG) of the vocalis muscle in thyroid surgery are controversial. Thus, we developed a novel IONM system with an accelerometer sensor that uses the piezoelectric effect instead of EMG to detect laryngeal twitching. The objective of this study was to evaluate the feasibility and safety of this novel IONM system during thyroid surgery in a porcine model. Methods.We developed an accelerometer sensor that uses the piezoelectric effect to measure laryngeal twitching in three dimensions. This novel accelerometer sensor was placed in the anterior neck skin (transcutaneous) or postcricoid area. Stimulus thresholds, amplitude, and latency of laryngeal twitching measured using the accelerometer sensor were compared to those measured through EMG of the vocalis muscle.Results. The amplitudes of the accelerometer sensor at the anterior neck and postcricoid area were significantly lower than those of EMG because of differences in the measurement method used to evaluate laryngeal movement. However, no significant differences in stimulus thresholds between the EMG endotracheal tube and transcutaneous or postcricoid accelerometer sensors were observed. Conclusion.Accelerometer sensors located at the anterior neck or postcricoid area were able to identify laryngeal twitching. The stimulus intensity measured with these sensors was equivalent to that from conventional vocalis EMG. Our novel IONM system with an accelerometer sensor that checks changes in surface acceleration can be an alternative to EMG of the vocalis muscle for IONM in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Development of a Novel Intraoperative Neuromonitoring System Using an Accelerometer Sensor in Thyroid Surgery: A Porcine Model Study

Sung

Lee

Shin

et al. 2019

Clin Exp Otorhinolaryngol

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“…Different feasible options for IONM include electromyographical systems on an endotracheal tube (ETT) (surface recording electrodes) or tube adhesive electrodes and transcutaneous stimulation of the more proximal vagus nerve for anatomic assessment of RLN integrity. [ 3 4 ]…”

mentioning

confidence: 99%

Intraoperative neural monitoring in head and neck surgeries: Feasibility and concerns

Kaur

2019

J Anaesthesiol Clin Pharmacol

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Full percutaneous intraoperative neuromonitoring technique in remote thyroid surgery: Porcine model feasibility study

et al. 2020

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Background: In remote thyroid surgery, a reliable intraoperative neuromonitoring (IONM) procedure is an important tool for reducing injury to recurrent laryngeal nerve (RLN). This study proposes an alternative or adjunct technique for performing full percutaneous (PC) IONM and confirms its feasibility in animal experiments. Methods: This prospective porcine model study enrolled four piglets with eight nerve sides. Evoked electromyography (EMG) was stimulated from PC ball-tip probe, and recorded from EMG endotracheal tube (ETT) and from PC paired long-needle electrodes on the perichondrium of the lateral aspect of thyroid cartilage. Results: In all RLNs and vagus nerves, typical laryngeal EMG waveforms were successfully evoked by PC probe stimulation and recorded by both ETT and PC needle electrodes. Conclusions: This study confirms the feasibility of the full PC IONM techniques in porcine model. However, further clinical studies are needed to compare the practicality of different remote-access approaches for thyroid surgery.

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Transcutaneous Recording During Intraoperative Neuromonitoring in Thyroid Surgery

Cited by 34 publications

References 26 publications

Development of a Novel Intraoperative Neuromonitoring System Using an Accelerometer Sensor in Thyroid Surgery: A Porcine Model Study

Development of a Novel Intraoperative Neuromonitoring System Using an Accelerometer Sensor in Thyroid Surgery: A Porcine Model Study

Intraoperative neural monitoring in head and neck surgeries: Feasibility and concerns

Full percutaneous intraoperative neuromonitoring technique in remote thyroid surgery: Porcine model feasibility study

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