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Research Letter |

A Novel Method of Neuromonitoring in Thyroidectomy and Parathyroidectomy Using Transcutaneous Intraoperative Vagal Stimulation

Insoo Suh, MD1,2; Charles Yingling, PhD3; Gregory W. Randolph, MD4; Quan-Yang Duh, MD1,2
[+] Author Affiliations
1Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, Medical Center at Mount Zion, San Francisco
2Surgical Service, Veterans Affairs Medical Center, San Francisco, California
3Golden Gate Neuromonitoring, San Francisco, California
4Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Boston
JAMA Surg. 2016;151(3):290-292. doi:10.1001/jamasurg.2015.3249.
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This study reports on a novel method of transcutaneous intraoperative vagal stimulation in the upper neck that is less invasive and is feasible in thyroidectomy and parathyroidectomy.

Intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) function is commonly performed for patients undergoing thyroidectomy or parathyroidectomy.1 Although its routine use remains controversial, IONM has demonstrated utility in selected situations, such as cases of reoperation.2,3 Intraoperative neuromonitoring using specific stimulation of the more proximal vagus nerve is thought to provide more complete anatomic analysis of RLN integrity than that of isolated distal segments of the RLN alone.4 However, current vagal IONM methods typically entail placing an electrode around the vagus for continuous electrical stimulation. This requires additional dissection of, and fixation to, the nerve, which, in theory, adds time and increases risk.5 We hypothesize that a novel method of transcutaneous intraoperative vagal stimulation (TIVS) in the upper neck is less invasive and is feasible in thyroidectomy and parathyroidectomy.

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Figure.
Representative Traces Recorded From Endotracheal Electrode to Stimulation at 3 Different Anatomic Sites

The latency periods progressively shorten from the proximal vagus nerve to the midcervical vagus nerve and then to the recurrent laryngeal nerve (RLN) (horizontal calibration, 2 milliseconds/division; vertical calibration, 100 µV/division).

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