title: Vagal nerve stimulation without dissecting the carotid sheath during intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery.
abstract: BACKGROUND
  Vagal nerve stimulation (VNS) has been recommended as a routine procedure during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN). However, many surgeons have been discouraged from performing VNS because of the need for opening the carotid sheath. The purpose of this study was to investigate the feasibility and reliability of VNS without carotid sheath dissection.
  
  
  METHODS
  Two hundred twenty patients with 376 nerves at risk were enrolled in this study. VNS without nerve exposure during IONM was applied by simply pressing a ball-tip stimulator on the space between the carotid artery and jugular vein.
  
  
  RESULTS
  VNS without nerve exposure was feasible in all cases and did not result in any morbidity. All VNS signals were successfully obtained within 30 minutes of the start of the operation and all showed a clear and reliable laryngeal electromyography (EMG) response that was similar to that from the conventional method in which nerve exposure for VNS is applied.
  
  
  CONCLUSIONS
  VNS without dissecting the carotid sheath is feasible and reliable, rendering it a simple, safe, and surgeon-friendly procedure during IONM.
authors.affiliation: Faculty of Medicine and Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital and Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan.
authors.forename: Che-Wei
authors.initials: CW
authors.lastname: Wu
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.forename: Hui-Chun
authors.initials: HC
authors.lastname: Chen
authors.forename: Hsiu-Ya
authors.initials: HY
authors.lastname: Chen
authors.forename: Ka-Wo
authors.initials: KW
authors.lastname: Lee
authors.forename: I-Cheng
authors.initials: IC
authors.lastname: Lu
authors.forename: Pi-Ying
authors.initials: PY
authors.lastname: Chang
authors.forename: Pi-Jung
authors.initials: PJ
authors.lastname: Hsiao
authors.forename: Kuen-Yao
authors.initials: KY
authors.lastname: Ho
authors.forename: Feng-Yu
authors.initials: FY
authors.lastname: Chiang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002346:Carotid Sinus; D004210:Dissection; D004576:Electromyography / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006042:Goiter / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D061214:Patient Safety; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control*; D015203:Reproducibility of Results; D018570:Risk Assessment; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000379:methods*; D055815:Young Adult