Real-time monitoring of the recurrent laryngeal nerve: An observational clinical trial

Ulmer, Christoph; Koch, Klaus Peter; Seimer, Andreas; Molnar, Viktor; Meyding‐Lamadé, Uta; Thon, Klaus‐Peter; Lamadé, Wolfram

doi:10.1016/j.surg.2007.10.007

Cited by 86 publications

(78 citation statements)

References 23 publications

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“…Beside two anecdotal reports of local and cardiac complications during CIONM in a very few patients (20,21), there are several clinical data showing no evidence of adversity related to the circular dissection of the a vagal nerve segment or related intrinsically to CIONM (11,15,17,19,(22)(23)(24)(25)(26)(27).…”

Section: Safety Of Continuous Neural Monitoringmentioning

confidence: 99%

Continuous intraoperative neural monitoring of the recurrent nerves in thyroid surgery: a quantum leap in technology

et al. 2016

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Section: Safety Of Continuous Neural Monitoringmentioning

confidence: 99%

Continuous intraoperative neural monitoring of the recurrent nerves in thyroid surgery: a quantum leap in technology

et al. 2016

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“…Reduction in amplitude and increase in latency of the laryngeal EMG signifies imminent injury to the RLN. In thyroidectomy, this system has been shown to be useful (3,4). We describe the adaptation of a commercially available continuous nerve monitoring equipment-NIM 3.0 with APS (Medtronic Inc., Jacksonville, FL, USA) for use in video-assisted thoracoscopic (VATS) minimally invasive esophagectomy (MIE).…”

Section: Review Article On Esophageal Surgerymentioning

confidence: 99%

Continuous intraoperative vagus nerve stimulation for monitoring of recurrent laryngeal nerve during minimally invasive esophagectomy

Wong¹,

Tong²,

Tsang³

et al. 2017

J. Vis. Surg

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For squamous cell carcinoma of the esophagus, extended mediastinal lymphadenectomy especially around the bilateral recurrent laryngeal nerves (RLN) is associated with high risk of nerve injury.This does not only result in hoarseness of voice, increase the chance of pulmonary complications, but would also affect the quality of life of patients in the long term. Methods to improve safety of lymphadenectomy are desirable. Continuous intraoperative nerve monitoring (CIONM) based on a system using vagus nerve stimulation was tested. In thyroidectomy, this system has been shown to be useful. Our patient cohort was when the electrical signal is picked by an electrode on the endotracheal tune. It detects the amplitude of the electromyography (EMG) of the vocalis muscle as well as its latency of nerve conduction. Reduction in amplitude and increase in latency of the laryngeal EMG signifies imminent injury to the RLN. In thyroidectomy, this system has been shown to be useful (3,4). We describe the adaptation of a commercially available continuous nerve monitoring equipment-NIM 3.0 with APS (Medtronic Inc., Jacksonville, FL, USA) for use in video-assisted thoracoscopic (VATS) minimally invasive esophagectomy (MIE). A pilot study of ten patients has been published recently (5). Patient selection and workupExtended lymphadenectomy is associated with increased morbidity; many surgeons would be selective in its application only in good risk patients. After neoadjuvant chemoradiotherapy, many would also shy away from RLN dissection, especially in the context of VATS esophagectomy. Radiotherapy may result in more fibrosis with obscured tissue planes and it is hard to differentiate cancer infiltration from post radiation fibrosis. In other cases, the tissue may actually become more edematous, easing dissection (6). In the TIME (Traditional Invasive vs. MIE) trial, the primary end-point is difference in pulmonary infection rates between open and MIE. The pulmonary complication rate and the RLN palsy rate were lower in the minimally invasive group while other complications and mortality rates were not significantly different. Bilateral RLN nodal dissection however was not routinely performed (7). Our patients were unselected; the intent was to perform bilateral RLN dissection in a consecutive group of patients. All patients had VATS esophagectomy and 52.5% had had prior chemoradiotherapy. Given the patient population, a higher RLN injury rate may be expected. The incidence of right RLN injury was expectedly to be low, since the nerve is more constant in its position and the area that requires dissection is small. But for the left side, after chemoradiation nearly twice the rate of nerve palsy was found compared to those who had not although the numbers were still small to make this statistically significant. It is the author's experience that after chemoradiation to the superior mediastinum, dissection in the left paratracheal area is more difficult. To strike a balance between striving for cure and increased morbidity, i...

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“…Es ist somit möglich, aus der Interpretation der EMGSignale Rückschlüsse auf die auf den NLR einwirkenden Kräfte zu ziehen. Dies erfordert allerdings eine kontinuier liche Analyse der EMGSignale des NLR über die gesamte Dauer der Organpräpa ration, bei der kleinste Veränderungen der Nervenleitfähigkeit aufgezeigt wer den [14,15,20,21] Die absolute Dislokationsrate der Sa xophonelektrode betrug 0,125 Disloka tionen/NaR während es beim Einsatz der V3Elektrode zu 1,5 Dislokationen/NaR kam. Die Explantation der Saxophon elektrode war in allen Fällen durch allei nigen Zug am Elektrodenkabel möglich.…”

Section: Signalstabilität Als Grundvoraussetzung Für Kontinuierlichesunclassified

“…Die klinische Evalua tion lieferte vielversprechende Ergebnisse, sodass im Verlauf eine Weiterentwicklung des kontinuierlichen Neuromonitorings präsentiert wurde [21]. Über eine flexible, tripolare Vaguselektrode konnte eine kon tinuierliche Überwachung des NLR über dessen gesamten Verlauf durchgeführt werden.…”

Section: Diskussionunclassified

Signalstabilität als Grundvoraussetzung für kontinuierliches intraoperatives Neuromonitoring

Lamadé

Ulmer

Friedrich

et al. 2011

Chirurg

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Real-time monitoring of the recurrent laryngeal nerve: An observational clinical trial

Cited by 86 publications

References 23 publications

Continuous intraoperative neural monitoring of the recurrent nerves in thyroid surgery: a quantum leap in technology

Continuous intraoperative neural monitoring of the recurrent nerves in thyroid surgery: a quantum leap in technology

Continuous intraoperative vagus nerve stimulation for monitoring of recurrent laryngeal nerve during minimally invasive esophagectomy

Signalstabilität als Grundvoraussetzung für kontinuierliches intraoperatives Neuromonitoring

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