Development of a Novel Detachable Magnetic Nerve Stimulator for Intraoperative Neuromonitoring

Sung, Eui‐Suk; Lee, Jin‐Choon; Shin, Sung‐Chan; Choi, Sung-Won; Jung, Dawoon; Lee, Byung‐Joo

doi:10.1007/s00268-017-4159-4

Cited by 18 publications

(12 citation statements)

References 25 publications

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“…Another recent study introduced a detachable magnetic stimulator which could be attached to any metallic surgical instrument. is study also reported comparable nerve stimulation amplitudes between the detachable magnetic stimulator and a conventional stimulator [18]. e ARS is advantageous during the thyroid surgery in terms of time saving.…”

Section: Discussionsupporting

confidence: 51%

Feasibility of Attachable Ring Stimulator for Intraoperative Neuromonitoring during Thyroid Surgery

Kim

Moon

Chai

et al. 2020

International Journal of Endocrinology

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Objective. Stimulator-attached dissecting instruments are useful for intraoperative nerve monitoring during thyroidectomy. The aim of this study was to evaluate the feasibility of an attachable ring stimulator (ARS) by comparing the electromyography (EMG) amplitudes evoked by an ARS and a conventional stimulator. Methods. Medical records of fourteen patients who underwent thyroidectomy using intraoperative neuromonitoring between June and August 2019 were retrospectively reviewed. The amplitudes of V1, R1, R2, and V2 signals were checked using both the ARS and a conventional stimulator, at the same point. Results. Both stimulators were tested on 20 recurrent laryngeal nerves (RLNs) and 20 vagus nerves (VNs). In all the nerves, the amplitudes of V1, R1, R2, and V2 were greater than 500 μV. The mean amplitudes of V1, R1, R2, and V2 checked with the ARS were 1175, 1432, 1598, and 1279 μV, respectively. The mean amplitudes of V1, R1, R2, and V2 checked with the conventional stimulator were 1140, 1425, 1557, and 1217 μV, respectively. Difference between amplitudes evoked by the two stimulators for V1, R1, R2, and V2 was 77, 110, 102, and 99 μV, respectively. There was no statistical difference in the amplitudes between the two groups for V1, R1, R2, and V2. Conclusion. The ARS transferred electric stimulation as effectively as the conventional stimulator. It is an effective tool for repeated stimulation and facilitates continuous feedback regarding the functional integrity of nerves during thyroid surgery.

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Section: Discussionsupporting

confidence: 51%

Feasibility of Attachable Ring Stimulator for Intraoperative Neuromonitoring during Thyroid Surgery

Kim

Moon

Chai

et al. 2020

International Journal of Endocrinology

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“…There are some limitations on stimulating side and recording side during thyroid surgery under IONM. To overcome the problems of the stimulation side, the continuous IONM system was introduced [6], and attempts were made to connect the nerve stimulator with the surgical instrument [18-20]. But, there were few attempts to overcome the disadvantages of recording side like EMG during thyroid surgery.…”

Section: Discussionmentioning

confidence: 99%

Development of a Novel Intraoperative Neuromonitoring System Using a Surface Pressure Sensor to Detect Muscle Movement: A Rabbit Model Study

Sung

Lee

Shin

et al. 2019

Clin Exp Otorhinolaryngol

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Objectives False-negative or false-positive responses in intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroid surgery pose a challenge. Therefore, we developed a novel IONM system that uses a surface pressure sensor instead of EMG to detect muscle twitching. This study aimed to investigate the feasibility and safety of a new IONM system using a piezo-electric surface pressure sensor in an experimental animal model. Methods We developed the surface pressure sensor by modifying a commercial piezo-electric sensor. We evaluated the stimulus thresholds to detect muscle movement, as well as the amplitude and latency of the EMG and surface pressure sensor in six sciatic nerves of three rabbits, according to the stimulus intensity. Results The surface pressure sensor detected the muscle movements in response to a 0.1 mA stimulation of all six sciatic nerves. There were no differences in the thresholds of stimulus intensity between the surface pressure sensor and EMG recordings to detect muscle movements. Conclusion It is possible to measure the change in surface pressure by using a piezo-electric surface pressure sensor instead of EMG to detect muscle movement induced by nerve stimulation. The application of IONM using a piezo-electric surface pressure sensor during surgery is noninvasive, safe, and feasible. Measuring muscle twitching to identify the state of the nerves using the novel IONM system can be an alternative to recording of EMG responses.

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“…Conventional IONM is comprised of stimulation side and recording side. Recently, several new devices have been reported to overcome the disadvantages of IONM stimulation side [ 8 - 10 ]; moreover, several limitations of IONM recording side when performing electromyography (EMG) on the vocalis muscle, have been reported. First, it was reported that malposition of endotracheal surface electrodes occurs in 3.8% to 23% of the patients [ 11 - 13 ].…”

Section: Introductionmentioning

confidence: 99%

Application of Novel Intraoperative Neuromonitoring System Using an Endotracheal Tube With Pressure Sensor During Thyroid Surgery: A Porcine Model Study

Sung

Shin

Kwon

et al. 2020

Clin Exp Otorhinolaryngol

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Objectives. The loss of signal during intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroidectomy is one of the biggest problems. We have developed a novel IONM system with an endotracheal tube (ETT) with an attached pressure sensor instead of EMG to detect laryngeal twitching. The aim of the present study was to investigate the feasibility and reliability of this novel IONM system using an ETT with pressure sensor during thyroidectomy in a porcine model.Methods. We developed an ETT-attached pressure sensor that uses the piezoelectric effect to measure laryngeal muscle twitching. Stimulus thresholds, amplitude, and latency of laryngeal twitching evaluated using the pressure sensor were compared to those measured using transcartilage needle EMG. The measured amplitude changes by EMG and the pressure sensor during recurrent laryngeal nerve (RLN) traction injury were compared.Results. No significant differences in stimulus threshold intensity between EMG and the pressure sensor were observed. The EMG amplitude detected at 0.3 mA, increased with increasing stimulus intensity. When the stimulus was more than 1.0 mA, the amplitude showed a plateau. In a RLN traction injury experiment, the EMG amplitude did not recover even 20 minutes after stopping RLN traction. However, the pressure sensor showed a mostly recovery.Conclusion. The change in amplitude due to stimulation of the pressure sensor showed a pattern similar to EMG. Pressure sensors can be feasibly and reliably used for RLN traction injury prediction, RLN identification, and preservation through the detection of laryngeal muscle twitching. Our novel IONM system that uses an ETT with an attached pressure sensor to measure the change of surface pressure can be an alternative to EMG in the future.

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Development of a Novel Detachable Magnetic Nerve Stimulator for Intraoperative Neuromonitoring

Cited by 18 publications

References 25 publications

Feasibility of Attachable Ring Stimulator for Intraoperative Neuromonitoring during Thyroid Surgery

Feasibility of Attachable Ring Stimulator for Intraoperative Neuromonitoring during Thyroid Surgery

Development of a Novel Intraoperative Neuromonitoring System Using a Surface Pressure Sensor to Detect Muscle Movement: A Rabbit Model Study

Application of Novel Intraoperative Neuromonitoring System Using an Endotracheal Tube With Pressure Sensor During Thyroid Surgery: A Porcine Model Study

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