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

Affiliations
  • 1Department of Otolaryngology, Head and Neck Surgery and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University College of Medicine, Yangsan, Korea.
  • 2Department of Otolaryngology, Head and Neck Surgery and Medical Research Institute, Pusan National University College of Medicine, Busan, Korea. voiceleebj@gmail.com
  • 3Department of Biomedical Engineering, Pusan National University Hospital, Busan, Korea.

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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Development of a Novel Intraoperative Neuromonitoring System Using an Accelerometer Sensor in Thyroid Surgery: A Porcine Model Study
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Clin Exp Otorhinolaryngol. 2019;12(4):420-426.    doi: 10.21053/ceo.2019.00423.

Application of an Intraoperative Neuromonitoring System Using a Surface Pressure Sensor in Parotid Surgery: A Rabbit Model Study
Eui-Suk Sung, Hyun-Keun Kwon, Sung-Chan Shin, Young-Il Cheon, Jung-Woo Lee, Da-Hee Park, Seong-Wook Choi, Hwa-Bin Kim, Hye-Jin Park, Jin-Choon Lee, Jung-Hoon Ro, Byung-Joo Lee
Clin Exp Otorhinolaryngol. 2021;14(1):131-136.    doi: 10.21053/ceo.2019.01900.

A New Era of Intraoperative Neuromonitoring: Beyond the Electromyography Endotracheal Tube During Thyroid Surgery
Sung-Chan Shin, Byung-Joo Lee
Clin Exp Otorhinolaryngol. 2020;13(4):324-325.    doi: 10.21053/ceo.2020.01158.

Application of Novel Intraoperative Neuromonitoring System Using an Endotracheal Tube With Pressure Sensor During Thyroid Surgery: A Porcine Model Study
Eui-Suk Sung, Sung-Chan Shin, Hyun-Keun Kwon, Jia Kim, Da-Hee Park, Seong-Wook Choi, Sang-Hoon Kim, Jin-Choon Lee, Jung-Hoon Ro, Byung-Joo Lee
Clin Exp Otorhinolaryngol. 2020;13(3):291-298.    doi: 10.21053/ceo.2019.01249.

Intraoperative Neuromonitoring System Using Needle and Skin Electrode during Thyroid Surgery
Sung-Chan Shin, Myeonggu Seo, Yong-Il Cheon, Byung-Joo Lee
Int J Thyroidol. 2022;15(1):17-22.    doi: 10.11106/ijt.2022.15.1.17.


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