We developed a simple attachable endoscopic nerve stimulator that can be connected to monopolar cauterization surgical instruments. This study on porcine models aimed to investigate the feasibility and efficacy of an attachable endoscopic nerve stimulator for intraoperative neuromonitoring (IONM) before application in humans. We evaluated the electromyography (EMG) amplitudes of 8 recurrent laryngeal nerves in 4 pigs with a conventional nerve probe and the attachable endoscopic nerve stimulator. The attachable endoscopic nerve stimulator was feasible and safe in all cases. There was no significant difference in the EMG amplitude of the recurrent laryngeal nerve among instruments ( P = .429). The application of stimulating dissection with an attachable endoscopic nerve stimulator during endoscopic or robotic thyroidectomy with IONM is simple, convenient, and effective. It provides surgeons with real-time feedback of the EMG response during intermittent IONM. We believe that this novel device could be an essential guide and functional navigator for most surgeons, especially for less experienced ones.

The term "gossypiboma" refers to a mass of the cotton matrix that is left in the body following an operation. It can remain silent postoperatively and appear several years later with a variety of symptoms or non-specific radiological findings. In addition, gossypiboma that persists in the human body for a long time can cause many complications when surgically removed. We report the case of a 33-year-old man who underwent rhinoseptoplasty and presented with nasal obstruction by a foreign body sensation. On endoscopic examination, protruding fabric material and granulation tissue were detected in the medial portion of the left nasal septum. Severe adhesion between the gossypiboma and septal mucosa resulted in a significant defect in the septal mucosa after endoscopic removal. The septum was approximated and reconstructed using a posterior-based inferior turbinate flap. The nasal obstruction completely resolved after surgery, and the septum healed at the six-month follow-up. This case emphasizes the possibility of gossypiboma when missing gauze remains in the patient after rhinoseptoplasty and a large septal perforation occurs as a consequence of gossypiboma removal. Rhinoplasty surgeons should be cautious to prevent materials being left inside the patient and efficiently follow-up on patients with nonspecific postoperative complaints.