Continuous intraoperative neuromonitoring in thyroid surgery: Safety analysis of 400 consecutive electrode probe placements with standardized procedures

Alberto Mangano, Hoon Yub Kim, Chei Wei Wu, Stefano Rausei, Sun Hui, Liu Xiaoli, Feng Yu Chiang, Dimitrios H. Roukos, Georgios D. Lianos, Erivelto Volpi, Gianlorenzo Dionigi

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)E1568-E1574
JournalHead and Neck
Volume38
DOIs
Publication statusPublished - 2016 Apr 1

Keywords

  • continuous intraoperative neuromonitoring
  • guidelines
  • safety
  • standardized surgical technique
  • thyroid surgery

ASJC Scopus subject areas

  • Otorhinolaryngology

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