title: Continuous intraoperative neuromonitoring in thyroid surgery: Safety analysis of 400 consecutive electrode probe placements with standardized procedures.
abstract: Continuous intraoperative neuromonitoring (C-IONM) is a new technology and it is appropriate to analyze its safety.
  
  
  
  C-IONM was performed according to a standardized technique to control any adverse events and electrode positioning issues.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: First Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Mangano
authors.affiliation: Department of Surgery, Division of Breast and Endocrine Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital Seoul, Seoul, Korea.
authors.forename: Hoon Yub
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors.forename: Chei-Wei
authors.initials: CW
authors.lastname: Wu
authors.affiliation: First Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rausei
authors.affiliation: Jilin Provincial Key Laboratory of Surgical Translational Medicine, Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun City, Jilin Province, China.
authors.forename: Sun
authors.initials: S
authors.lastname: Hui
authors.affiliation: Jilin Provincial Key Laboratory of Surgical Translational Medicine, Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun City, Jilin Province, China.
authors.forename: Liu
authors.initials: L
authors.lastname: Xiaoli
authors.affiliation: Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors.forename: Feng-Yu
authors.initials: FY
authors.lastname: Chiang
authors.affiliation: Department of General Surgery Ioannina University Hospital, Centre for Biosystems and Genomic Network Medicine Ioannina University, Ioannina, Greece.
authors.forename: Dimitrios H
authors.initials: DH
authors.lastname: Roukos
authors.affiliation: Department of General Surgery Ioannina University Hospital, Centre for Biosystems and Genomic Network Medicine Ioannina University, Ioannina, Greece.
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Lianos
authors.affiliation: Department of Head and Neck Surgery, University of São Paulo, São Paulo, Brazil.
authors.forename: Erivelto
authors.initials: E
authors.lastname: Volpi
authors.affiliation: First Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy.
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
mesh_terms: D004566:Electrodes; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000295:instrumentation / Q000379:methods*; D061214:Patient Safety; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy; D055536:Vagus Nerve Stimulation
keywords: continuous intraoperative neuromonitoring; guidelines; safety; standardized surgical technique; thyroid surgery