Stimulating dissecting instruments during neuromonitoring of RLN in thyroid surgery

Feng Yu Chiang, I. Cheng Lu, Pi Ying Chang, Hui Sun, Ping Wang, Xiu Bo Lu, Hui Chun Chen, Hsiu Ya Chen, Hoon Yub Kim, Gianlorenzo Dionigi, Che Wei Wu

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)


Objectives/Hypothesis During intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery, the need for frequent shifting between the dissecting instruments and stimulating probe is troublesome and time-consuming. Therefore, use of these two instruments in combination would be a noticeable future direction. This study aimed to investigate the feasibility and safety of using stimulating dissecting instruments (SDIs) that combine the function of surgical dissection and nerve stimulation during IONM. Study Design Prospective outcomes research. Methods One hundred consecutive patients with 168 RLNs at risk were enrolled. We developed prototypes of SDIs and applied them to early detect adverse EMG changes during the risky phase of RLN dissection. In the case of substantial EMG change (amplitude decrease > 50%) during dissection, the surgical maneuver was paused and thyroid traction was released immediately. Results The application of SDIs was feasible in all cases and did not result in any morbidity. Nineteen RLNs were detected with substantial EMG change that was caused by traction stress during dissection with SDIs and that featured progressive gradual EMG recovery after releasing thyroid traction. After thyroid resection, 10 RLNs had a weak point of nerve conduction detected at region of Berry's ligament, but only one nerve with 79% amplitude reduction developed postoperative temporary vocal palsy. Conclusion The application of SDIs is a simple and effective way to monitor the nerve's function instantly during the risky phase of RLN injury in thyroid surgery. It provides surgeons with real-time feedback of EMG response and can be applied as a tool for the early detection of adverse EMG change caused by traction distress. Level of Evidence 4.

Original languageEnglish
Pages (from-to)2832-2837
Number of pages6
Issue number12
Publication statusPublished - 2015 Dec 1
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2015 The American Laryngological, Rhinological and Otological Society, Inc.


  • electromyography
  • intraoperative neuromonitoring
  • recurrent laryngeal nerve
  • stimulating dissecting instruments
  • thyroid surgery

ASJC Scopus subject areas

  • Otorhinolaryngology


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