Pre-Prototype Stimulating and Recording Endotracheal Tube for Continuous Monitoring of the Recurrent Laryngeal Nerve During Thyroid Surgery

Abstract

Introduction

Continuous intraoperative neural monitoring (C-IONM) is a promising technology used to decrease recurrent laryngeal nerve (RLN) damage during thyroid surgery. However, C-IONM use is limited due to its challenging application. C-IONM requires dissection of the carotid sheath and placement of an electrode around the vagus nerve (VN). In our study, we simultaneously stimulated and monitored the proximal RLN trans-tracheally using surface electrodes that were positioned solely on the endotracheal tube.

Methods

We described the design, implementation, and testing of a pre-prototype, combined stimulating and recording endotracheal tube (SRET) that continually delivered current from tube edge, and tested the function of the RLN at the vocal cords (VC). The SRET was tested in vivo on 10 RLNs using 5 pigs as animal models.

Results

The SRET was capable of the following, delivery of continuous trans-tracheal stimulation to the proximal RLN, continuous trans-tracheal stimulation-induced VC movement, and standard ipsilateral RLN biphasic waveforms with latency and amplitude; and recording evoked responses were recorded in the ipsilateral RLN.

Conclusion

The pre-prototype SRET represents a possible advancement in technology because it simplified the C-IONM. Thus, the SRET provides a minimally invasive, alternative application to the C-IONM vagal nerve cuff electrodes.

Keywords:

• Pre-prototype
• nerve monitoring
• continuous nerve monitoring
• recurrent laryngeal nerve
• thyroid surgery
• stimulation and recording endotracheal tube
• EMG
• amplitude
• latency
• waveform
• morbidity

This article is referred to by:

A Novel Approach to Continuous Monitoring of the Recurrent Laryngeal Nerve during Thyroid Surgery

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

Study protocol was approved by the Institutional Review Board.

Informed consent

Informed consent not required for this study.

Availability of data and materials

Datasets analyzed are available on reasonable request.