Related Experiment Video
Updated: Jun 1, 2026
Intra-Operative Neural Monitoring of Thyroid Surgery in a Porcine Model
Published on: February 11, 2019
Impact of continuous intraoperative neuromonitoring on autonomic nervous system during thyroid surgery
Christoph Ulmer1, Colin Friedrich, Andrea Kohler
1Department of General and Visceral Surgery, Robert-Bosch-Hospital, Stuttgart, Germany. christoph.ulmer@rbk.de
Background:
Continuous intraoperative neuromonitoring (CIONM) via vagal nerve stimulation (VNS) is a new option for recurrent laryngeal nerve (RLN) protection during thyroid surgery. The aim of this study was to evaluate the safety of VNS for CIONM and to assess its effects on the autonomic nervous system (ANS) through analyzing heart rate variability (HRV).
Methods:
In a prospective, nonrandomized controlled study 5 patients received VNS for CIONM and 5 were operated on with conventional intermittent intraoperative neuromonitoring (IONM). HRV was analyzed in accord with patient-specific reference values.
Results:
VNS resulted in significantly altered ANS balance. Relative parasympathetic activity increased during VNS. Yet, no relevant cardiac arrhythmias or hemodynamic alterations were observed during VNS.
Conclusion:
HRV analysis revealed a distinct impact of VNS for CIONM on ANS balance. VNS caused parasympathetic predominance that was not countered by increased sympathetic activity.
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