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Vagal nerve stimulation without dissecting the carotid sheath during intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery

Authors

  • Che-Wei Wu MD,

    1. Faculty of Medicine and Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    2. Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital and Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan
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  • Gianlorenzo Dionigi MD,

    1. Endocrine Surgery Research Centre, Department of Surgical Sciences, University of Insubria, Varese–Como, Varese, Italy
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  • Hui-Chun Chen CNS,

    1. Department of Nursing, Kaohsiung Medical University Hospital, Taiwan
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  • Hsiu-Ya Chen NA,

    1. Department of Anesthesiology, Kaohsiung Medical University Hospital, Taiwan
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  • Ka-Wo Lee MD,

    1. Faculty of Medicine and Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    2. Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital and Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan
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  • I-Cheng Lu MD,

    1. Faculty of Medicine and Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    2. Department of Anesthesiology, Kaohsiung Medical University Hospital, Taiwan
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  • Pi-Ying Chang MD,

    1. Department of Anesthesiology, Kaohsiung Medical University Hospital, Taiwan
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  • Pi-Jung Hsiao MD,

    1. Faculty of Medicine and Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    2. Endocrinology and Metabolism Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan
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  • Kuen-Yao Ho MD,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital and Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan
    • Faculty of Medicine and Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Feng-Yu Chiang MD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital and Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan
    • Faculty of Medicine and Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • This study has been registered as a clinical trial at Clinicaltrials.gov; Identifier NCT00629746.

Department of Otolaryngology – Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, TaiwanDepartment of Otolaryngology – Head and Neck Surgery, Kaohsiung Medical University, 100 TzYou First Road, Kaohsiung City 807, Taiwan. E-mail: fychiang@kmu.edu.tw

Abstract

Background

Vagal nerve stimulation (VNS) has been recommended as a routine procedure during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN). However, many surgeons have been discouraged from performing VNS because of the need for opening the carotid sheath. The purpose of this study was to investigate the feasibility and reliability of VNS without carotid sheath dissection.

Methods

Two hundred twenty patients with 376 nerves at risk were enrolled in this study. VNS without nerve exposure during IONM was applied by simply pressing a ball-tip stimulator on the space between the carotid artery and jugular vein.

Results

VNS without nerve exposure was feasible in all cases and did not result in any morbidity. All VNS signals were successfully obtained within 30 minutes of the start of the operation and all showed a clear and reliable laryngeal electromyography (EMG) response that was similar to that from the conventional method in which nerve exposure for VNS is applied.

Conclusions

VNS without dissecting the carotid sheath is feasible and reliable, rendering it a simple, safe, and surgeon-friendly procedure during IONM. © 2012 Wiley Periodicals, Inc. Head Neck 35: 1443–1447, 2013

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