Pre-Prototype Stimulating and Recording Endotracheal Tube for Continuous Monitoring of the Recurrent Laryngeal Nerve During Thyroid Surgery

Zhang, Daqi; Wang, Tie; Zhao, Yishen; Sun, Hui; Pino, Antonella; Kim, Hoon Yub; Dionigi, Gianlorenzo

doi:10.1080/08941939.2020.1734693

Cited by 9 publications

(11 citation statements)

References 27 publications

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“…In our initial clinical experience, the full PC neuromonitoring approach did not cause gas insufflation leaks during surgery and did not cause scarring after surgery. On the other hand, the use of gasless remote thyroid surgery has increased, particularly after introduction of the single pole robotic system 13,36,37 . Although gas leak is not an issue in the single pole system, further research is needed to optimize the neuromonitoring procedure used in the transoral single pole approach.…”

Section: Discussionmentioning

confidence: 99%

“…Some novel IONM devices have shown high potential for future use in remote surgery. For example, the transtracheal stimulating and recording EMG tube firstly published by Lamade et al 38 in 1998 and recently reinvestigated by Zhang et al 37 in 2020, and also the laryngeal adductor reflex EMG tube by Sinclair et al 39 in 2018 for continuous neural monitoring in thyroid surgery. Since the EMG tube obtains continuous signals and does not require VN dissection, it is particularly useful when distal to proximal dissection of the RLN is required, for example, in transoral approach.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the use of gasless remote thyroid surgery has increased, particularly after introduction of the single pole robotic system. 13,36,37 Although gas leak is not an issue in the single pole system, further research is needed to optimize the neuromonitoring procedure used in the transoral single pole approach.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…In addition, it is extremely important to avoid nerve devascularization during its mobilization which needs proper training and surgical skills. Hence, the commented study describing a pre-prototype of a trans-tracheal stimulation and recording endotracheal tube (SRET) for the stimulation of RLN in the neck is of interest in the field as it has a potential to provide continuous RLN monitoring while avoiding the need for the vagus nerve dissection [9]. This proof of concept was tested on 10 RLNs in 5 pigs as animal models with encouraging initial results.…”

mentioning

confidence: 99%

“…This proof of concept was tested on 10 RLNs in 5 pigs as animal models with encouraging initial results. Authors found that SRET was capable to deliver a continuous trans-tracheal stimulation to the proximal end of the RLN resulting in ipsilateral vocal fold movements which were recorded by superficial electrodes on endotracheal tube as biphasic waveforms with latency and amplitude (evoked responses following stimulation of the ipsilateral RLN) [9].…”

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confidence: 99%

A Novel Approach to Continuous Monitoring of the Recurrent Laryngeal Nerve during Thyroid Surgery

Barczyński

2020

Journal of Investigative Surgery

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

Huang

Hsu

et al. 2021

Laryngoscope Investig Oto

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Objective: Proper position of an electromyographic (EMG) endotracheal tube within the larynx plays a key role in functional electrophysiologic intraoperative neural monitoring (IONM) in thyroid surgery. The purpose of this study was to determine the feasibility of a portable video-assisted intubation device (UEScope) to verify the optimal placement of an EMG tube.Methods: A retrospective study enrolled 40 consecutive patients who underwent monitored thyroidectomies. After positioning the patient for surgery, an anesthesiologist performed tracheal intubation with UEScope and checked the position of the tube at the proper depth without rotation to the vocal cords. The main outcome measured was the proper EMG tube position, free from further adjustment. The secondary outcomes assessed were the percentage of available initial vagal stimulation (V1) signals.Results: All tracheal intubations were successful at first attempt. Proper EMG tube placement without position adjustment was found in 97.5% of the patients. Tube withdrawal was required in a male patient. All patients obtained detectable V1 signals; the lowest and median V1 amplitude was 485 and 767 μV as a reference value, respectively. Conclusion:The UEScope is a valuable and reliable tool for placing an EMG tube and confirming its position during monitored thyroidectomy. In addition, further tube adjustment might be waived in most cases when the anesthesiologist placed the I-Cheng Lu and Che-Wei Wu contributed equally to this work.

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Pre-Prototype Stimulating and Recording Endotracheal Tube for Continuous Monitoring of the Recurrent Laryngeal Nerve During Thyroid Surgery

Cited by 9 publications

References 27 publications

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

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

A Novel Approach to Continuous Monitoring of the Recurrent Laryngeal Nerve during Thyroid Surgery

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

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