World Congress on Thyroid Cancer 3.5
Rome, Italy | 2019
World Congress on Thyroid Cancer 4.0
July 29 – August 1, 2021
WCTC3.5 Steering Committee:
Rocco Bellatone, Co-Chair
Celestino Lombardi, Co-Chair
Gregory W. Randolph, MD
Bryan McIver, MD
Jeremy Freeman, MD
Ian J. Witterick, MD
Ashok R. Shaha, MD
Jatin P. Shah, MD
OP81 – Development of a novel detachable magnetic nerve stimulator for intraoperative neuromonitoring
Lee, Byung-Joo1, Shin, Sung-Chan1, Wang, Soo-Geun1; Lee, Jin-Choon2; Ro, Jung-Hoon3; Sung, Eui-Suk2
1 Department of Otolaryngology – Head and Neck Surgery, College of Medicine, Pusan National University, Pusan, South Korea
2 Department of Otolaryngology – Head and Neck Surgery, College of Medicine, Pusan National University, Yangsan, South Korea
3 Department of Biomedical Engineering, Pusan National University Hospital, Pusan, South Korea
Background: Recurrent laryngeal nerve palsy is a serious complication of thyroid and parathyroid surgery. During intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery, repeated shifting between surgical instrument and nerve stimulator is troublesome and time consuming. Therefore, we developed a simple detachable magnetic nerve stimulator that can be connected to all metallic surgical instruments. This study aimed to investigate the feasibility and efficacy of a detachable magnetic nerve stimulator for intraoperative neuromonitoring in animal and human.
Methods: Eight recurrent laryngeal nerves in four pigs and thirteen recurrent laryngeal nerves in nine patients that underwent thyroidectomy were tested. We developed a detachable nerve stimulator that combined the surgical instrument and nerve-stimulating probe. We evaluated the electromyography amplitudes of the eight recurrent laryngeal nerves at pig and thirteen recurrent laryngeal nerves at patients using conventional nerve probes and surgical instruments with novel detachable magnetic nerve stimulator.
Results: The amplitudes of the electromyographic recordings of the eight recurrent laryngeal nerves at pigs and thirteen recurrent laryngeal nerves at patients were analyzed. The detachable magnetic nerve stimulator was feasible and safe in all cases. There was no significant difference in the amplitude of electromyography of the recurrent laryngeal nerve between instruments
Discussion & Conclusion: The application of stimulating dissection using a detachable magnetic nerve stimulator during thyroidectomy with intraoperative neuromonitoring is simple, convenient, and effective. It provides surgeons with real-time feedback of the electromyographic response during intermittent intraoperative neuromonitoring. We believe that this novel device could be an essential guide for most surgeons, especially for less experienced head and neck surgeons.
- Munch S, deKryger L. A piece of my mind. Moral wounds: complicated complications. JAMA 2001; 285:1131-1132.
- Chiang FY, Lu IC, Kuo WR, Lee KW, Chang NC, Wu CW. The mechanism of recurrent laryngeal nerve injury during thyroid surgery–the application of intraoperative neuromonitoring. Surgery 2008; 143:743-749.
- Dionigi G, Alesina PF, Barczynski M, et al. Recurrent laryngeal nerve injury in video-assisted thyroidectomy: lessons learned from neuromonitoring. Surgical endoscopy 2012; 26:2601-2608.
- Randolph GW, Dralle H, Abdullah H, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. The Laryngoscope 2011; 121 Suppl 1:S1-16.
- Chiang FY, Lu IC, Chen HC, et al. Intraoperative neuromonitoring for early localization and identification of recurrent laryngeal nerve during thyroid surgery. The Kaohsiung journal of medical sciences 2010; 26:633-639.
- Dionigi G, Wu CW, Kim HY, Rausei S, Boni L, Chiang FY. Severity of Recurrent Laryngeal Nerve Injuries in Thyroid Surgery. World journal of surgery 2016; 40:1373-1381.
- Dionigi G, Donatini G, Boni L, et al. Continuous monitoring of the recurrent laryngeal nerve in thyroid surgery: a critical appraisal. International journal of surgery (London, England) 2013; 11 Suppl 1:S44-46.
- Wu CW, Dionigi G, Sun H, et al. Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery: a porcine model. Surgery 2014; 155:329-339.
- Almquist M, Thier M, Salem F. Cardiac arrest with vagal stimulation during intraoperative nerve monitoring. Head & neck 2016; 38:E2419-e2420.
- Chiang FY, Lu IC, Chang PY, et al. Stimulating dissecting instruments during neuromonitoring of RLN in thyroid surgery. The Laryngoscope 2015; 125:2832-2837.
- Snyder SK, Lairmore TC, Hendricks JC, Roberts JW. Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidectomy and parathyroidectomy. Journal of the American College of Surgeons 2008; 206:123-130.
- Liu XL, Wu CW, Zhao YS, et al. Exclusive real-time monitoring during recurrent laryngeal nerve dissection in conventional monitored thyroidectomy. The Kaohsiung journal of medical sciences 2016; 32:135-141.
- Schneider R, Randolph GW, Sekulla C, et al. Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Head & neck 2013; 35:1591-1598.
- Phelan E, Schneider R, Lorenz K, et al. Continuous vagal IONM prevents recurrent laryngeal nerve paralysis by revealing initial EMG changes of impending neuropraxic injury: a prospective, multicenter study. The Laryngoscope 2014; 124:1498-1505.
- Lin YC, Dionigi G, Randolph GW, et al. Electrophysiologic monitoring correlates of recurrent laryngeal nerve heat thermal injury in a porcine model. The Laryngoscope 2015; 125:E283-290.