Sung-Chan Shin1, Eui-Suk Sung2, Sung-Won Choi1, Sung-Dong Kim1, Da-Woon Jung1, Seok-Hyun Kim2, Jung Hoon Ro3, Jin-Choon Lee2, Byung-Joo Lee4. 1. Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Pusan, Republic of Korea. 2. Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, Republic of Korea. 3. Department of Biomedical Engineering, Pusan National University School of Medicine, Yangsan, Gyeongsangnam-do, Republic of Korea. 4. Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Pusan, Republic of Korea. Electronic address: voiceleebj@gmail.com.
Abstract
BACKGROUND: Recently, several energy-based devices (EBDs) have been developed and applied in the context of thyroid surgery. EBDs can reduce operation time, blood loss, and postoperative pain. Compared to conventional electrocautery, EBDs operate at a relatively lower temperature and produce minimal lateral tissue damage. Yet, during device operation, the tip of the EBD is hot enough to cause thermal nerve damage, increasing the need for surgeons to be cautious about EBD application. To increase the safety of EBDs, we attached nerve stimulators to the tips of two EBDs and compared them to conventional monopolar nerve stimulation using a porcine model. METHODS: Three piglets (30-40 kg) underwent total thyroidectomy after orotracheal intubation with a nerve integrity monitor (NIM) electromyography (EMG) endotracheal tube. Nerve stimulators were attached to two EBDs (Harmonic Focus®+ and LigaSure™). After dissection and identification of six recurrent laryngeal nerves in the three piglets, both of the EBDs with attached nerve stimulators and a conventional monopolar nerve stimulator were applied near the nerve and EMG parameters were recorded using the NIM 3.0 system. The stimulus intensity was varied from 5 mA to 1 mA and the maximum distance and amplitude at which nerve detection was achieved were measured. RESULTS: There were no statistically significant differences between the maximum distance or mean amplitude obtained from nerve stimulators attached to EBDs and those obtained from the conventional nerve stimulator. Additionally, there were no adverse EMG events related to the use of nerve stimulators attached to EBDs. CONCLUSIONS: Attachment of a nerve stimulator to an EBD for nerve detection during thyroidectomy was as safe and effective as attachment of a conventional nerve stimulator. Use of a nerve stimulator attachment may reduce the likelihood of EBD-associated nerve damage during thyroid surgery.
BACKGROUND: Recently, several energy-based devices (EBDs) have been developed and applied in the context of thyroid surgery. EBDs can reduce operation time, blood loss, and postoperative pain. Compared to conventional electrocautery, EBDs operate at a relatively lower temperature and produce minimal lateral tissue damage. Yet, during device operation, the tip of the EBD is hot enough to cause thermal nerve damage, increasing the need for surgeons to be cautious about EBD application. To increase the safety of EBDs, we attached nerve stimulators to the tips of two EBDs and compared them to conventional monopolar nerve stimulation using a porcine model. METHODS: Three piglets (30-40 kg) underwent total thyroidectomy after orotracheal intubation with a nerve integrity monitor (NIM) electromyography (EMG) endotracheal tube. Nerve stimulators were attached to two EBDs (Harmonic Focus®+ and LigaSure™). After dissection and identification of six recurrent laryngeal nerves in the three piglets, both of the EBDs with attached nerve stimulators and a conventional monopolar nerve stimulator were applied near the nerve and EMG parameters were recorded using the NIM 3.0 system. The stimulus intensity was varied from 5 mA to 1 mA and the maximum distance and amplitude at which nerve detection was achieved were measured. RESULTS: There were no statistically significant differences between the maximum distance or mean amplitude obtained from nerve stimulators attached to EBDs and those obtained from the conventional nerve stimulator. Additionally, there were no adverse EMG events related to the use of nerve stimulators attached to EBDs. CONCLUSIONS: Attachment of a nerve stimulator to an EBD for nerve detection during thyroidectomy was as safe and effective as attachment of a conventional nerve stimulator. Use of a nerve stimulator attachment may reduce the likelihood of EBD-associated nerve damage during thyroid surgery.
Authors: Jongjin Kim; Hyeon Jong Moon; Young Jun Chai; Jung-Man Lee; Ki-Tae Hwang; Che-Wei Wu; Gianlorenzo Dionigi; Hoon Yub Kim; Kyung Sik Park; Sang Wan Kim; Ka Hee Yi Journal: Int J Endocrinol Date: 2020-01-30 Impact factor: 3.257