First continuous nerve monitoring in thyroid surgery

A new "all in one" sensing device was developed for continuous transtrachea l intraoperative monitoring and in situ detection of the recurrent laryngea l nerve (RLN) during thyroid surgery. Patients and methods. The new system is based on a double-balloon endotracheal tube with integrated atraumatic s timulating and tracing electrodes. The recurrent laryngeal nerve is stimula ted transtracheally and compound action potentials are recorded from the la ryngeal muscles. Fifty-five patients were introduced into a phase-one clini cal trial. Thirty-five patients with primary thyroid operations, 20 patient s with reoperations, 10 of whom had neck dissections. All patients were eva luated laryngoscopically and phoniatrically by an ENT specialist before and after surgery. Results: Compound muscle action potentials were recorded co ntinuously during the whole operation and responded sensitively to tension and pressure to the nerve. There were no accidental permanent RLN palsies. Conclusion: The new system offers five advantages: (1) it is atraumatic; (2 ) it is easy to use; (3) it can monitor continuously with an audio feedback to the surgeon; (4) it works outside the operation field, and (5) it is hi ghly sensitive, even indicating reversible irritation to the nerve.