Development of a Novel Intraoperative Neuromonitoring System Using an Accelerometer Sensor in Thyroid Surgery: A Porcine Model Study
2
조회
0
다운로드
5
인용
0
참고문헌
키워드
초록
Objectives. The sensitivity and positive predictive value of widely used intraoperative neuromonitoring (IONM) using electromyography (EMG) of the vocalis muscle in thyroid surgery are controversial. Thus, we developed a novel IONM system with an accelerometer sensor that uses the piezoelectric effect instead of EMG to detect laryngeal twitching. The objective of this study was to evaluate the feasibility and safety of this novel IONM system during thyroid surgery in a porcine model. Methods. We developed an accelerometer sensor that uses the piezoelectric effect to measure laryngeal twitching in three dimensions. This novel accelerometer sensor was placed in the anterior neck skin (transcutaneous) or postcricoid area. Stimulus thresholds, amplitude, and latency of laryngeal twitching measured using the accelerometer sensor were compared to those measured through EMG of the vocalis muscle. Results. The amplitudes of the accelerometer sensor at the anterior neck and postcricoid area were significantly lower than those of EMG because of differences in the measurement method used to evaluate laryngeal movement. However, no significant differences in stimulus thresholds between the EMG endotracheal tube and transcutaneous or postcricoid accelerometer sensors were observed. Conclusion. Accelerometer sensors located at the anterior neck or postcricoid area were able to identify laryngeal twitching. The stimulus intensity measured with these sensors was equivalent to that from conventional vocalis EMG. Our novel IONM system with an accelerometer sensor that checks changes in surface acceleration can be an alternative to EMG of the vocalis muscle for IONM in the future.
Abstract
Objectives. The sensitivity and positive predictive value of widely used intraoperative neuromonitoring (IONM) using electromyography (EMG) of the vocalis muscle in thyroid surgery are controversial. Thus, we developed a novel IONM system with an accelerometer sensor that uses the piezoelectric effect instead of EMG to detect laryngeal twitching. The objective of this study was to evaluate the feasibility and safety of this novel IONM system during thyroid surgery in a porcine model. Methods. We developed an accelerometer sensor that uses the piezoelectric effect to measure laryngeal twitching in three dimensions. This novel accelerometer sensor was placed in the anterior neck skin (transcutaneous) or postcricoid area. Stimulus thresholds, amplitude, and latency of laryngeal twitching measured using the accelerometer sensor were compared to those measured through EMG of the vocalis muscle. Results. The amplitudes of the accelerometer sensor at the anterior neck and postcricoid area were significantly lower than those of EMG because of differences in the measurement method used to evaluate laryngeal movement. However, no significant differences in stimulus thresholds between the EMG endotracheal tube and transcutaneous or postcricoid accelerometer sensors were observed. Conclusion. Accelerometer sensors located at the anterior neck or postcricoid area were able to identify laryngeal twitching. The stimulus intensity measured with these sensors was equivalent to that from conventional vocalis EMG. Our novel IONM system with an accelerometer sensor that checks changes in surface acceleration can be an alternative to EMG of the vocalis muscle for IONM in the future.
참고문헌 (37)
- Haugen BR, "2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer : The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer", Thyroid, 26(1), pp.1~133 (2016)
- Chandrasekhar SS, "Clinical practice guideline:improving voice outcomes after thyroid surgery", Otolaryngol Head Neck Surg, 148(6 Suppl), pp.S1~S37 (2013)
- Munch S, "A piece of my mind. Moral wounds: complicated complications", JAMA, 285(9), pp.1131~1132 (2001)
- Jeannon JP, "Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy : a systematic review", Int J Clin Pract, 63(4), pp.624~629 (2009)
- Riddell V, "Thyroidectomy: prevention of bilateral recurrent nerve palsy. Results of identification of the nerve over 23 consecutive years (1946-69) with a description of an additional safety measure", Br J Surg, 57(1), pp.1~11 (1970)
- Hermann M, "Laryngeal recurrent nerve injury in surgery for benign thyroid diseases : effect of nerve dissection and impact of individual surgeon in more than 27, 000 nerves at risk", Ann Surg, 235(2), pp.261~268 (2002)
- Chiang FY, "Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve", Surgery, 137(3), pp.342~347 (2005)
- Randolph GW, "Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery : international standards guideline statement", Laryngoscope, 1, pp.S1~16 (2011)
- Terris DJ, "American Thyroid Association statement on outpatient thyroidectomy", Thyroid, 23(10), pp.1193~1202 (2013)
- Chen AY, "American Thyroid Association statement on optimal surgical management of goiter", Thyroid, 24(2), pp.181~189 (2014)
- Chiang FY, "Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation", World J Surg, 34(2), pp.223~229 (2010)
- 성의숙, "갑상선 수술을 위한 새로운 수술 중 신경감시시스템의개발", International Journal of Thyroidology, 11(2), pp.109~116 (2018), 대한갑상선학회[DOI]
- 성의숙, "Development of a Novel Intraoperative Neuromonitoring System Using a Surface Pressure Sensor to Detect Muscle Movement: A Rabbit Model Study", Clinical and Experimental Otorhinolaryngology, 12(2), pp.217~223 (2019), 대한이비인후과학회[DOI]
- Sung ES, "Development of an attachable endoscopic nerve stimulator for intraoperative neuromonitoring during endoscopic or robotic thyroidectomy", Otolaryngol Head Neck Surg, 158(3), pp.465~468 (2018)
- Shin SC, "Feasibility and safety of nerve stimulator attachment to energy-based devices : a porcine model study", Int J Surg, 48, pp.155~159 (2017)
- Khan A, "Experience with two types of electromyography monitoring electrodes during thyroid surgery", Am J Otolaryngol, 18(2), pp.99~102 (1997)
- Tschopp KP, "Comparison of various methods of electromyographic monitoring of the recurrent laryngeal nerve in thyroid surgery", Ann Otol Rhinol Laryngol, 111(9), pp.811~816 (2002)
- Rea JL, "Clinical evoked electromyography for recurrent laryngeal nerve preservation : use of an endotracheal tube electrode and a postcricoid surface electrode", Laryngoscope, 108(9), pp.1418~1420 (1998)
- Marcus B, "Recurrent laryngeal nerve monitoring in thyroid and parathyroid surgery : the University of Michigan experience", Laryngoscope, 113(2), pp.356~361 (2003)
- Liddy W, "Monitoring of the posterior cricoarytenoid muscle represents another option for neural monitoring during thyroid surgery : normative vagal and recurrent laryngeal nerve posterior cricoarytenoid muscle electromyographic data", Laryngoscope, 128(1), pp.283~289 (2018)
- Wu CW, "Feasibility of intraoperative neuromonitoring during thyroid surgery using transcartilage surface recording electrodes", Thyroid, 28(11), pp.1508~1516 (2018)
- Wu CW, "Transcutaneous recording during intraoperative neuromonitoring in thyroid surgery", Thyroid, 28(11), pp.1500~1507 (2018)
- Dralle H, "Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery", World J Surg, 32(7), pp.1358~1366 (2008)
- Bai B, "Protective effects of intraoperative nerve monitoring(IONM)for recurrent laryngeal nerve injury in thyroidectomy : meta-analysis", Sci Rep, 8(1), pp.7761~ (2018)
- Sanabria A, "Neuromonitoring in thyroidectomy : a meta-analysis of effectiveness from randomized controlled trials", Eur Arch Otorhinolaryngol, 270(8), pp.2175~2189 (2013)
- Lifante JC, "A prospective, randomized trial of nerve monitoring of the external branch of the superior laryngeal nerve during thyroidectomy under local", regional anesthesia and IV sedation, 2009, pp.146(6), 1167~1173
- Barczynski M, "Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy", Br J Surg, 96(3), pp.240~246 (2009)
- Higgins TS, "Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy : a meta-analysis", Laryngoscope, 121(5), pp.1009~1017 (2011)
- Dionigi G, "Neuromonitoring and video-assisted thyroidectomy : a prospective, randomized casecontrol evaluation", Surg Endosc, 23(5), pp.996~1003 (2009)
- Chan WF, "Pitfalls of intraoperative neuromonitoring for predicting postoperative recurrent laryngeal nerve function during thyroidectomy", World J Surg, 30(5), pp.806~812 (2006)
- Chiang FY, "The mechanism of recurrent laryngeal nerve injury during thyroid surgery : the application of intraoperative neuromonitoring", Surgery, 143(6), pp.743~749 (2008)
- Dionigi G, "What is the learning curve for intraoperative neuromonitoring in thyroid surgery?", Int J Surg, 6(Suppl 1), pp.S7~S12 (2008)
- Kim HY, "Impact of positional changes in neural monitoring endotracheal tube on amplitude and latency of electromyographic response in monitored thyroid surgery : results from the porcine experiment", Head Neck, 38(Suppl 1), pp.E1004~E1008 (2016)
- Wu CW, "Loss of signal in recurrent nerve neuromonitoring : causes and management", Gland Surg, 4(1), pp.19~26 (2015)
- Chiang FY, "Comparison of EMG signals recorded by surface electrodes on endotracheal tube and thyroid cartilage during monitored thyroidectomy", Kaohsiung J Med Sci, 33(10), pp.503~509 (2017)
- Randolph GW, "Recurrent laryngeal nerve identification and assessment during thyroid surgery : laryngeal palpation", World J Surg, 28(8), pp.755~760 (2004)
- Puram SV, "Posterior cricoarytenoid muscle electrophysiologic changes are predictive of vocal cord paralysis with recurrent laryngeal nerve compressive injury in a canine model", Laryngoscope, 126(12), pp.2744~2751 (2016)