title: Stimulating dissecting instruments during neuromonitoring of RLN in thyroid surgery.
abstract: OBJECTIVE
  During intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery, the need for frequent shifting between the dissecting instruments and stimulating probe is troublesome and time-consuming. Therefore, use of these two instruments in combination would be a noticeable future direction. This study aimed to investigate the feasibility and safety of using stimulating dissecting instruments (SDIs) that combine the function of surgical dissection and nerve stimulation during IONM.
  
  
  METHODS
  Prospective outcomes research.
  
  
  METHODS
  One hundred consecutive patients with 168 RLNs at risk were enrolled. We developed prototypes of SDIs and applied them to early detect adverse EMG changes during the risky phase of RLN dissection. In the case of substantial EMG change (amplitude decrease > 50%) during dissection, the surgical maneuver was paused and thyroid traction was released immediately.
  
  
  RESULTS
  The application of SDIs was feasible in all cases and did not result in any morbidity. Nineteen RLNs were detected with substantial EMG change that was caused by traction stress during dissection with SDIs and that featured progressive gradual EMG recovery after releasing thyroid traction. After thyroid resection, 10 RLNs had a weak point of nerve conduction detected at region of Berry's ligament, but only one nerve with 79% amplitude reduction developed postoperative temporary vocal palsy.
  
  
  CONCLUSIONS
  The application of SDIs is a simple and effective way to monitor the nerve's function instantly during the risky phase of RLN injury in thyroid surgery. It provides surgeons with real-time feedback of EMG response and can be applied as a tool for the early detection of adverse EMG change caused by traction distress.
  
  
  METHODS
  4.
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University (KMU), Kaohsiung, Taiwan.|Faculty of Medicine, Graduate Institute of Clinical Medicine, and Department of Respiratory Therapy, College of Medicine, KMU, Kaohsiung, Taiwan.
authors: Feng-Yu
authors: FY
authors: Chiang
authors: Department of Anesthesiology, Kaohsiung Medical University (KMU).|Faculty of Medicine, Graduate Institute of Clinical Medicine, and Department of Respiratory Therapy, College of Medicine, KMU, Kaohsiung, Taiwan.
authors: I-Cheng
authors: IC
authors: Lu
authors: Department of Anesthesiology, Kaohsiung Medical University (KMU).
authors: Pi-Ying
authors: PY
authors: Chang
authors: Department of Thyroid and Parathyroid Surgery, China-Japan Union Hospital, Jilin University & Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, Jilin.
authors: Hui
authors: H
authors: Sun
authors: Department of Surgery, the 2nd Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang.
authors: Ping
authors: P
authors: Wang
authors: Department of Thyroid Surgery, the first Affiliated Hospital of Zhengzhou University, Henan, China.
authors: Xiu-Bo
authors: XB
authors: Lu
authors: Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University (KMU), Kaohsiung, Taiwan.
authors: Hui-Chun
authors: HC
authors: Chen
authors: Department of Anesthesiology, Kaohsiung Medical University (KMU).
authors: Hsiu-Ya
authors: HY
authors: Chen
authors: Department of Surgery, Korea University College of Medicine (h.y.k.), Seoul, Korea.
authors: Hoon Yub
authors: HY
authors: Kim
authors: Endocrine Surgery Research Center, Department of Surgical Sciences and Human Morphology, University of Insubria, Varese-Como, Varese, Italy.
authors: Gianlorenzo
authors: G
authors: Dionigi
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University (KMU), Kaohsiung, Taiwan.|Faculty of Medicine, Graduate Institute of Clinical Medicine, and Department of Respiratory Therapy, College of Medicine, KMU, Kaohsiung, Taiwan.
authors: Che-Wei
authors: CW
authors: Wu
mesh_terms: D000328:Adult; D000368:Aged; D004210:Dissection; D004576:Electromyography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies; D012009:Recurrent Laryngeal Nerve / Q000601:surgery*; D061226:Recurrent Laryngeal Nerve Injuries / Q000503:physiopathology*; D013525:Surgical Instruments; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult
keywords: electromyography; intraoperative neuromonitoring; recurrent laryngeal nerve; stimulating dissecting instruments; thyroid surgery