Application of Novel Intraoperative Neuromonitoring System Using an Endotracheal Tube With Pressure Sensor During Thyroid Surgery: A Porcine Model Study

Eui-Suk Sung; Sung-Chan Shin; Hyun-Keun Kwon; Jia Kim; Da-Hee Park; Seong-Wook Choi; Sang-Hoon Kim; Jin-Choon Lee; Jung-Hoon Ro; Byung-Joo Lee

doi:10.21053/ceo.2019.01249

Clinical and Experimental Otorhinolaryngology (Aug 2020)

Application of Novel Intraoperative Neuromonitoring System Using an Endotracheal Tube With Pressure Sensor During Thyroid Surgery: A Porcine Model Study

Eui-Suk Sung,
Sung-Chan Shin,
Hyun-Keun Kwon,
Jia Kim,
Da-Hee Park,
Seong-Wook Choi,
Sang-Hoon Kim,
Jin-Choon Lee,
Jung-Hoon Ro,
Byung-Joo Lee

Affiliations

Eui-Suk Sung: Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
Sung-Chan Shin: Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, Korea
Hyun-Keun Kwon: Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
Jia Kim: Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, Korea
Da-Hee Park: Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
Seong-Wook Choi: Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
Sang-Hoon Kim: Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, Korea
Jin-Choon Lee: Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
Jung-Hoon Ro: Department of Biomedical Engineering, Pusan National University Hospital, Busan, Korea
Byung-Joo Lee: Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, Korea

DOI: https://doi.org/10.21053/ceo.2019.01249
Journal volume & issue: Vol. 13, no. 3
pp. 291 – 298

Abstract

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Objectives The loss of signal during intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroidectomy is one of the biggest problems. We have developed a novel IONM system with an endotracheal tube (ETT) with an attached pressure sensor instead of EMG to detect laryngeal twitching. The aim of the present study was to investigate the feasibility and reliability of this novel IONM system using an ETT with pressure sensor during thyroidectomy in a porcine model. Methods We developed an ETT-attached pressure sensor that uses the piezoelectric effect to measure laryngeal muscle twitching. Stimulus thresholds, amplitude, and latency of laryngeal twitching evaluated using the pressure sensor were compared to those measured using transcartilage needle EMG. The measured amplitude changes by EMG and the pressure sensor during recurrent laryngeal nerve (RLN) traction injury were compared. Results No significant differences in stimulus threshold intensity between EMG and the pressure sensor were observed. The EMG amplitude detected at 0.3 mA, increased with increasing stimulus intensity. When the stimulus was more than 1.0 mA, the amplitude showed a plateau. In a RLN traction injury experiment, the EMG amplitude did not recover even 20 minutes after stopping RLN traction. However, the pressure sensor showed a mostly recovery. Conclusion The change in amplitude due to stimulation of the pressure sensor showed a pattern similar to EMG. Pressure sensors can be feasibly and reliably used for RLN traction injury prediction, RLN identification, and preservation through the detection of laryngeal muscle twitching. Our novel IONM system that uses an ETT with an attached pressure sensor to measure the change of surface pressure can be an alternative to EMG in the future.

Published in Clinical and Experimental Otorhinolaryngology

ISSN: 1976-8710 (Print); 2005-0720 (Online)
Publisher: Korean Society of Otorhinolaryngology-Head and Neck Surgery
Country of publisher: Korea, Republic of
LCC subjects: Medicine: Otorhinolaryngology
Website: https://www.e-ceo.org/

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