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Novel use of Continuous Vagus Stimulation in a Robotic Transaxillary Thyroidectomy

This 44-year-old patient previously underwent a robotic–assisted right thyroid lobectomy and was found to have papillary carcinoma. She had another suspicious nodule (2.1cm) on the left side that continued to grow and the FNA biopsy Showed follicular lesion of undetermined significance. The video illustrates the steps of flap creation. Then illustrated the steps of placing the APS electrodes on the vagus nerve for continuous vagal stimulation to recognize early stretch. Initial stimulation of the Vagus nerve revealed evidence amplitude of 455uV and latency 4.6msec. After dissection of the carotid, the Vagus nerve was identified and circumferentially dissected. Then, An Autonomous Periodic Stimulation (APS) electrode was placed on it for continuous stimulation. A good signal was recorded (amplitude 450uV, latency of 4.6msec). Final stimulation of the Vagus showed Amplitude: 403uV, latency: 4.6msec final stimulation of the recurrent nerve showed amplitude: 361uV and latency: 1.2msec.