Application Of Patch Stimulator For Intraoperative Neuromonitoring During Thyroid Surgery: Maximizing Surgeon'S Convenience

Background: Intraoperative neuromonitoring (IONM) is frequently used in thyroid surgery to reduce recurrent laryngeal nerve (RLN) injury by providing the surgeon with real-time feedback on nerve stimulation during dissection. We applied a disposable adhesive patch electrode to a dissecting instrument to transfer electrical stimulation to the dissecting instrument for IONM during thyroid surgery. This study aimed to evaluate the feasibility of using the patch stimulator approach for IONM during thyroid surgery.Methods: We reviewed the medical records of patients who underwent thyroidectomy using both conventional stimulator and adhesive patch stimulator for IONM. The electromyography (EMG) amplitudes of the vagal and the RLNs before (V1, R1) and after thyroid resection (V2, R2) were alternatively checked with each type of stimulator at the same location of each nerve.Results: Fifteen consecutive patients (4 males, 11 females) were included in this analysis, and a total of 38 nerves (19 vagus nerves and 19 RLNs) were evaluated. No statistically significant differences were seen in the mean amplitudes evoked by the patch stimulator and the conventional probe stimulator for the V1 signal (825.5 +/- 394.6 vs. 821.8 +/- 360.9 mu V, P=0.954), R1 signal (1,044.8 +/- 471.2 vs. 1,039.2 +/- 507.4 mu V, P=0.898), R2 signal (1,037.8 +/- 495.0 vs. 938.2 +/- 415.8 mu V, P=0.948), or V2 signal (812.5 +/- 391.9 vs. 787.3 +/- 355.7 mu V, P=0.975).Conclusions: The patch stimulator was safely and effectively used for IONM during thyroid surgery and provided similar nerve monitoring responses as the conventional stimulator. This approach may be used to enhance the surgeon's convenience during thyroid surgery.