New backstrap vagus electrode for continuous intraoperative neuromonitoring in thyroid surgery

Area of Science:

• Neurosurgery
• Biomedical Engineering
• Surgical Technology

Background:

• Continuous intraoperative neuromonitoring (CIONM) is crucial for real-time recurrent laryngeal nerve surveillance during thyroid surgery.
• Effective CIONM requires precise detection of subtle changes in nerve conductivity.
• A novel stimulation electrode designed for stable and safe application is introduced.

Purpose of the Study:

• To present a newly developed tripolar gold/polyimide stimulation electrode for vagal nerve stimulation.
• To validate the electrode's performance through simulation, bench testing, and clinical evaluation.
• To assess the electrode's suitability for reliable CIONM in thyroid surgery.

Main Methods:

• Finite element method simulations for current distribution analysis.
• Bench testing to evaluate mechanical characteristics.
• Clinical evaluation in 11 thyroid surgery cases.

Main Results:

• Development of a tripolar gold/polyimide electrode on a silicone backstrap.
• Facilitated rapid implantation (median 4 ± 19 seconds) and extraction.
• Achieved reliable electromyogram responses with median stimulation currents of 2.00 ± 0.95 mA.
• Demonstrated no intraoperative dislocations or postoperative nerve palsy.

Conclusions:

• The novel backstrap vagal stimulation electrode meets CIONM requirements.
• The electrode ensures stable nerve stimulation and safe application.
• The device supports reliable recurrent laryngeal nerve monitoring during thyroid procedures.