[First continuous nerve monitoring in thyroid gland surgery].
A new "all in one" sensing device was developed for continuous transtracheal intraoperative monitoring and in situ detection of the recurrent laryngeal nerve (RLN) during thyroid surgery.


METHODS
The new system is based on a double-balloon endotracheal tube with integrated atraumatic stimulating and tracing electrodes. The recurrent laryngeal nerve is stimulated transtracheally and compound action potentials are recorded from the laryngeal muscles. Fifty-five patients were introduced into a phase-one clinical trial. Thirty-five patients with primary thyroid operations, 20 patients with reoperations, 10 of whom had neck dissections. All patients were evaluated laryngoscopically and phoniatrically by an ENT specialist before and after surgery.


RESULTS
Compound muscle action potentials were recorded continuously during the whole operation and responded sensitively to tension and pressure to the nerve. There were no accidental permanent RLN palsies.


CONCLUSIONS
The new system offers five advantages: (1) it is atraumatic; (2) it is easy to use; (3) it can monitor continuously with an audio feedback to the surgeon; (4) it works outside the operation field; and (5) it is highly sensitive, even indicating reversible irritation to the nerve.
Lamadé
W
W
Chirurgische Universitätsklinik, Heidelberg. Wolfram.lamade@urz. heidelberg.de
Meyding-Lamadé
U
U
Buchhold
C
C
Brauer
M
M
Brandner
R
R
Uttenweiler
V
V
Motsch
J
J
Klar
E
E
Herfarth
C
C
D000328:Adult; D000368:Aged; D004558:Electric Stimulation / Q000295:instrumentation; D004576:Electromyography / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D012009:Recurrent Laryngeal Nerve / Q000503:physiopathology; D061226:Recurrent Laryngeal Nerve Injuries; D012086:Reoperation; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation; D013965:Thyroidectomy; D014826:Vocal Cord Paralysis / Q000503:physiopathology / Q000517:prevention & control*
Erstes kontinuierliches Nerven-Monitoring in der Schilddrüsenchirurgie.