title: Automatic periodic stimulation of the vagus nerve during single-incision transaxillary robotic thyroidectomy: Feasibility, safety, and first cases.
abstract: BACKGROUND
  Automatic periodic stimulation (APS) of the vagus nerve during thyroid surgery may provide the patient with increased safety to prevent impending thermal or stretch-related injury to the recurrent laryngeal nerve (RLN).
  
  
  METHODS
  Vagal stimulation would be of particular interest in remote access robotic thyroid surgery, where the RLN may be exposed to more conducted heat because of the exclusive use of the Harmonic scalpel. Using APS, the console surgeon may adjust the dissection technique according to the signal changes to avoid impending thermal damage to the nerve.
  
  
  RESULTS
  In 2 transaxillary robotic thyroidectomy cases, we placed the vagus electrode onto the ipsilateral vagus trunk through the single-incision transaxillary access before docking the da Vinci robot. APS of the ipsilateral nerve has been conducted without complications.
  
  
  CONCLUSIONS
  APS of the ipsilateral vagus is feasible and safe during transaxillary robotic thyroidectomy, and may contribute to prevent impending thermal injury to the RLN.
authors.affiliation: Head and Neck Cancer Center of the Hubertus Wald University Cancer Center Hamburg, Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Balazs B
authors.initials: BB
authors.lastname: Lörincz
authors.affiliation: Head and Neck Cancer Center of the Hubertus Wald University Cancer Center Hamburg, Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Möckelmann
authors.affiliation: Head and Neck Cancer Center of the Hubertus Wald University Cancer Center Hamburg, Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Chia-Jung
authors.initials: CJ
authors.lastname: Busch
authors.affiliation: Head and Neck Cancer Center of the Hubertus Wald University Cancer Center Hamburg, Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Hezel
authors.affiliation: Head and Neck Cancer Center of the Hubertus Wald University Cancer Center Hamburg, Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Rainald
authors.initials: R
authors.lastname: Knecht
mesh_terms: D001365:Axilla / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006044:Goiter, Nodular / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D016343:Monitoring, Intraoperative / Q000379:methods; D012009:Recurrent Laryngeal Nerve; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control*; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D055536:Vagus Nerve Stimulation / Q000379:methods*
keywords: intraoperative neuromonitoring (IONM); recurrent laryngeal nerve (RLN); robotic thyroid surgery; transaxillary robotic surgery; vagal automatic periodic stimulation (APS)