Clin Exp Otorhinolaryngol.  2019 May;12(2):217-223. 10.21053/ceo.2018.01207.

Development of a Novel Intraoperative Neuromonitoring System Using a Surface Pressure Sensor to Detect Muscle Movement: A Rabbit Model Study

• Sung ES
• Lee JC
• Shin SC
• Kwon HG
• Kim MS
• Kim DJ
• Ro JH
• Lee BJ

• KMID: 2447432
• DOI: http://doi.org/10.21053/ceo.2018.01207

Abstract

OBJECTIVES
False-negative or false-positive responses in intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroid surgery pose a challenge. Therefore, we developed a novel IONM system that uses a surface pressure sensor instead of EMG to detect muscle twitching. This study aimed to investigate the feasibility and safety of a new IONM system using a piezo-electric surface pressure sensor in an experimental animal model.
METHODS
We developed the surface pressure sensor by modifying a commercial piezo-electric sensor. We evaluated the stimulus thresholds to detect muscle movement, as well as the amplitude and latency of the EMG and surface pressure sensor in six sciatic nerves of three rabbits, according to the stimulus intensity.
RESULTS
The surface pressure sensor detected the muscle movements in response to a 0.1 mA stimulation of all six sciatic nerves. There were no differences in the thresholds of stimulus intensity between the surface pressure sensor and EMG recordings to detect muscle movements.
CONCLUSION
It is possible to measure the change in surface pressure by using a piezo-electric surface pressure sensor instead of EMG to detect muscle movement induced by nerve stimulation. The application of IONM using a piezo-electric surface pressure sensor during surgery is noninvasive, safe, and feasible. Measuring muscle twitching to identify the state of the nerves using the novel IONM system can be an alternative to recording of EMG responses.

Keyword

Intraoperative Neurophysiological Monitoring; Surface Pressure Sensor; Electromyography; Recurrent Laryngeal Nerve; Thyroidectomy

MeSH Terms

Electromyography
Intraoperative Neurophysiological Monitoring
Models, Animal
Rabbits
Recurrent Laryngeal Nerve
Sciatic Nerve
Thyroid Gland
Thyroidectomy

Figure

• 

  Fig. 1. Photographs of the surgical field on the rabbit, demonstrating dissection using the surface pressure sensor. (A) Left sciatic nerve. (B) Modified patch-type piezo-electric surface pressure sensor. (C) A needle-electrode electromyography and modified patch-type piezo-electric surface pressure sensor on the skin. (D) Sciatic nerve stimulation with the nerve probe.

• 

  Fig. 2. Electromyography (EMG) and piezo-electric surface pressure sensor recordings, showing the amplitude and latency of the EMG and surface pressure sensor for 0.3 mA stimulation using the Nerve Integrity Monitor (NIM) 3.0 system in one rabbit. (A) EMG signal. (B) The modified piezo-electric surface pressure sensor signal.

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