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Continuous intraoperative neuromonitoring in thyroid surgery: Safety analysis of 400 consecutive electrode probe placements with standardized procedures
Author(s) -
Mangano Alberto,
Kim Hoon Yub,
Wu CheiWei,
Rausei Stefano,
Hui Sun,
Xiaoli Liu,
Chiang FengYu,
Roukos Dimitrios H.,
Lianos Georgios D.,
Volpi Erivelto,
Dionigi Gianlorenzo
Publication year - 2016
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.24280
Subject(s) - medicine , vagus nerve , anesthesia , electromyography , dissection (medical) , recurrent laryngeal nerve , thyroid , surgery , stimulation , psychiatry
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. © 2015 Wiley Periodicals, Inc. Head Neck 38 : E1568–E1574, 2016