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

Abstract

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.

Laryngeal Neural Monitoring during Pediatric Thyroid Cancer Surgery—Is Transcartilage Recording a Preferable Method?

“…Although the EMG ET recording electrode is now widely used in IONM, its major limitation is the need to maintain constant contact between the electrode and vocal cords during surgery to obtain a highquality recording [22,[38][39][40]. A tube that is malpositioned during intubation (e.g., due to rotation or due to incorrect tube size or insertion depth) or displaced during neck extension or surgical manipulation (e.g., patient positioning from intubation to neck extension, swallowing or other movement of the patient caused by a light plane of anesthesia, or surgery-related traction or pressure to the laryngo-trachea and anesthesia circuit, all of which can cause the tube to rotate or migrate from the optimal placement) can cause a decrease or complete loss of EMG signal upon neural stimulation [22,32,33,[38][39][40][41]. A false positive decrease or loss of signal may result in inappropriate surgical decisions, and verification or readjustment of the ET position can be complicated and time-consuming.…”

“…Recent clinical studies have further confirmed that, in adult thyroid surgery, TC-IONM provides significantly higher signal strength and stability and significantly less false signal compared to ET-IONM [25,26]. Therefore, TC-IONM is increasingly recognized as an acceptable alternative to ET-IONM and is gradually expanding to other aspects of thyroid surgery [27][28][29][30][31][32]. To our knowledge, however, use of this technique in pediatric populations had not been reported.…”

Optimization of electromyographic endotracheal tube electrode position by UEScope for monitored thyroidectomy

“…Cherng et al proposed middle‐mouth fixation to reduce the rotation of the EMG tube in a manikin study. 29 …”

New Developments in Anterior Laryngeal Recording Technique During Neuromonitored Thyroid and Parathyroid Surgery

“…Regarding the basis of anatomy, there are many innovative hypotheses and possible solutions including novel electrodes designs have been proposed. For example, many experimental (14)(15)(16)(17)(18) and clinical studies (19)(20)(21)(22)(23)(24)(25)(26)(27)(28) have confirmed the hypothesis that needle or adhesive surface recording electrodes attached to the thyroid cartilage (transcartilage or percutaneous recordings) or attached to the overlying neck skin (transcutaneous recording) can function like ET electrodes by enabling access to the EMG response of the vocal fold muscles (vocalis muscle and thyroarytenoid muscle) originating from the inner TC surface (Table 1, Figure 1). These studies have also demonstrated that transcutaneous or transcartilage anterior laryngeal (AL) recording electrodes are as accurate as ET-based surface electrodes in depicting RLN stress during IONM.…”