Nerve Monitoring and Stimulation During Endoscopic Neck Surgery in the Pig

Authors

  • Lisa Danielle Grunebaum MD,

    1. Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
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  • David Rosen MD,

    1. Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
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  • Howard D. Krein MD, PhD,

    1. Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
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  • William M. Keane MD,

    1. Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
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  • Mark Curtis MD,

    1. Department of Pathology, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
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  • Debra A. Tereschuk PA-C,

    1. Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
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  • Edmund A. Pribitkin MD

    Corresponding author
    1. Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    • Dr. Edmund de Azevedo Pribitkin, Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, Sixth Floor, Philadelphia, PA 19107, U.S.A.
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Abstract

Objectives: To determine the feasibility of recurrent laryngeal nerve monitoring and stimulation during endoscopic neck surgery in an animal model.

Study Design: Prospective, nonrandomized experimental investigation in a porcine model.

Methods: Bilateral recurrent laryngeal nerve monitoring and stimulation was accomplished during endoscopic neck surgery in five domestic pigs. Each pig was intubated with an electromyography endotracheal tube. Recurrent laryngeal nerve function was monitored throughout the endoscopic neck surgery with a nerve integrity monitor system. An endoscopic surgical pocket was created in the neck using blunt dissection followed by low-pressure carbon dioxide insufflation. Under direct endoscopic visualization, the trachea, thyroid gland, and associated vasculature were identified. The recurrent laryngeal nerve was identified on each side of the animal and was successfully stimulated with a monopolar stimulator probe.

Results: Ten of ten recurrent laryngeal nerves were successfully monitored and stimulated. No significant complications were encountered during the procedures.

Conclusions: Recurrent laryngeal nerve monitoring and stimulation may be successfully accomplished during endoscopic neck surgery.

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