Vagal nerve stimulation without dissecting the carotid sheath during intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery

Head Neck. 2013 Oct;35(10):1443-7. doi: 10.1002/hed.23154. Epub 2012 Sep 18.

Abstract

Background: Vagal nerve stimulation (VNS) has been recommended as a routine procedure during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN). However, many surgeons have been discouraged from performing VNS because of the need for opening the carotid sheath. The purpose of this study was to investigate the feasibility and reliability of VNS without carotid sheath dissection.

Methods: Two hundred twenty patients with 376 nerves at risk were enrolled in this study. VNS without nerve exposure during IONM was applied by simply pressing a ball-tip stimulator on the space between the carotid artery and jugular vein.

Results: VNS without nerve exposure was feasible in all cases and did not result in any morbidity. All VNS signals were successfully obtained within 30 minutes of the start of the operation and all showed a clear and reliable laryngeal electromyography (EMG) response that was similar to that from the conventional method in which nerve exposure for VNS is applied.

Conclusions: VNS without dissecting the carotid sheath is feasible and reliable, rendering it a simple, safe, and surgeon-friendly procedure during IONM.

Trial registration: ClinicalTrials.gov NCT00629746.

Keywords: carotid sheath dissection; intraoperative neuromonitoring; recurrent laryngeal nerve; thyroid surgery; vagal nerve stimulation.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carotid Sinus
  • Dissection
  • Electromyography / methods
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Goiter / pathology
  • Goiter / surgery
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Intraoperative / methods*
  • Patient Safety
  • Recurrent Laryngeal Nerve Injuries / prevention & control*
  • Reproducibility of Results
  • Risk Assessment
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / surgery
  • Thyroidectomy / adverse effects
  • Thyroidectomy / methods*
  • Treatment Outcome
  • Vagus Nerve Stimulation / methods*
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT00629746