Korean J Otorhinolaryngol-Head Neck Surg.  2021 Jun;64(6):416-421. 10.3342/kjorl-hns.2020.00822.

Efficacy of Intraoperative Neuromonitoring during Thyroidectomy with Transcutaneous Adhesive Skin Electrodes

• Seo SG
• Lee HS
• Jo KH
• Kim SW
• Lee KD

• KMID: 2517725
• DOI: http://doi.org/10.3342/kjorl-hns.2020.00822

Abstract

Background and Objectives
Variable types of electrodes for intraoperative neuromonitoring (IONM) during thyroid surgery have been introduced to make up for the shortcomings of conventional endotracheal electromyogram tube. In this study, we sought to evaluate the efficacy of transcutaneous adhesive skin electrodes for IONM of recurrent laryngeal nerve (RLN) during thyroidectomy.
Subjects and Method
A total 97 nerves at risk of 80 patients were enrolled in this study. Two disposable adhesive skin electrodes were attached at both upper margins of thyroid cartilage. Using NIM 3.0 system (Medtronic), we recorded the amplitude and latency of signals of vagus nerve and RLN following the standard procedure of IONM. Clinicopathologic factors as well as the preoperative and postoperative vocal cord functions of the patients were analyzed.
Results
IONM was successful in all nerves at risk without any false loss of signals. There were no complications nor any significant time delay due to adhesive skin electrodes. The mean amplitudes from the vagus nerve (V1) and RLN (R1) were 230.64 µV and 293.48 µV, respectively. Two nerves at risk showed loss of signal and the two patients showed postoperative temporary vocal cord paralysis. The amplitude of signals from the vagus nerve (V1, V2) was significantly higher in the lower body mass index (BMI) group compared to that of the higher BMI group.
Conclusion
IONM using transcutaneous skin electrodes may be considered as an alternative technique for IONM during thyroid surgery.

Keyword

Electrodes; Nerve monitoring; Neuromonitoring; Recurrent laryngeal nerve; Thyroidectomy