Alberto Mangano1, Hoon Yub Kim2, Chei-Wei Wu3, Stefano Rausei1, Sun Hui4, Liu Xiaoli4, Feng-Yu Chiang3, Dimitrios H Roukos5, Georgios D Lianos5, Erivelto Volpi6, Gianlorenzo Dionigi1. 1. First Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy. 2. Department of Surgery, Division of Breast and Endocrine Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital Seoul, Seoul, Korea. 3. Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan. 4. Jilin Provincial Key Laboratory of Surgical Translational Medicine, Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun City, Jilin Province, China. 5. Department of General Surgery Ioannina University Hospital, Centre for Biosystems and Genomic Network Medicine Ioannina University, Ioannina, Greece. 6. Department of Head and Neck Surgery, University of São Paulo, São Paulo, Brazil.
Abstract
BACKGROUND: Continuous intraoperative neuromonitoring (C-IONM) is a new technology and it is appropriate to analyze its safety. METHODS: C-IONM was performed according to a standardized technique to control any adverse events and electrode positioning issues. RESULTS: Four hundred vagal nerve dissections were analyzed considering vagal nerve diameter, mean time effort for C-IONM probe positioning, and electrode dislocation rate. A significant superior dislocation rate in case of: (a) when a 3 mm automatic periodic stimulating (APS) electrode size was used in a vagal nerve diameter <2 mm; (b) anterior access; and (c) vagal nerve A subtype in relation (p < .05). No related additional local or systemic morbidity was registered in this series. There was a statistically significant positive relationship between increased diameter of vagal nerve and increased electromyography (EMG) amplitude (p = .03). There was also a significant increase of amplitude between initial and final vagal nerve stimulation in uneventful cases (p = .02). CONCLUSION: We analyzed the technical issues to achieve improved vagal nerve critical view of safety dissection, stimulation, and C-IONM probe placement.
BACKGROUND: Continuous intraoperative neuromonitoring (C-IONM) is a new technology and it is appropriate to analyze its safety. METHODS:C-IONM was performed according to a standardized technique to control any adverse events and electrode positioning issues. RESULTS: Four hundred vagal nerve dissections were analyzed considering vagal nerve diameter, mean time effort for C-IONM probe positioning, and electrode dislocation rate. A significant superior dislocation rate in case of: (a) when a 3 mm automatic periodic stimulating (APS) electrode size was used in a vagal nerve diameter <2 mm; (b) anterior access; and (c) vagal nerve A subtype in relation (p < .05). No related additional local or systemic morbidity was registered in this series. There was a statistically significant positive relationship between increased diameter of vagal nerve and increased electromyography (EMG) amplitude (p = .03). There was also a significant increase of amplitude between initial and final vagal nerve stimulation in uneventful cases (p = .02). CONCLUSION: We analyzed the technical issues to achieve improved vagal nerve critical view of safety dissection, stimulation, and C-IONM probe placement.
Authors: Alessandra Cossa; Giorgio Castagnola; Gherardo Romeo; Marco Bellucci; Giuseppe Nigri; Carlo Bellotti Journal: Endocrine Date: 2020-05-19 Impact factor: 3.633