Advances in Intraoperative Neuromonitoring During Thyroid or Parathyroid Surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 DENGQiao-lian ^1,2 ,  ZHUJing-qiang ¹

1. Center of Thyroid Disease Diagnosis and Treatment, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;
2. Department of Thyroid and Breast Surgery, The Fisrt People's Hospital of Zigong City, Zigong 643000, Sichuan Province, China;

Corresponding?author：

ZHUJing-qiang, Email: zjq-wkys@163.com

Keywords：

Intraoperative neuromonitoring; Thyroid; Parathyroid

DOI：

10.7507/1007-9424.20150210

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To introduce the advances of intraoperative neuromonitoring (IONM) during thyroid or parathyroid surgery. Methods The literatures about IONM during thyroid or parathyroid surgery in recent years at home and abroad were collected and reviewed. Results IONM is improved from invasive to noninvasive:endotracheal intubation with electrode on its surface. Standardized procedures of IONM is developed. Intermittent monitoring is replaced by continuous monitoring. The monitoring of external branch of superior laryngeal nerve is also a supplement to laryngeal recurrent nerve. With the aid of IONM, non-recurrent laryngeal nerve could be identified easily, also injury spot, and damage degree. We could speculate probable damage mechanisms and prevent irreversible nerve damage through IONM. Conclusions IONM could be an effective technique to reduce the risk of recurrent laryngeal nerve injury during thyroid or parathyroid surgery, especially in complex surgery and reoperations, which could predict the postoperative function of laryngeal recurrent nerve, and help to avoid severe postoperative complications.

Citation： DENGQiao-lian, ZHUJing-qiang. Advances in Intraoperative Neuromonitoring During Thyroid or Parathyroid Surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(7): 811-815. doi: 10.7507/1007-9424.20150210 Copy

1.	?Chen TC, Rabb C, Apuzzo ML. Complex technical methodologies and their applications in the surgery of intracranial meningiomas. Neurosurg Clin N Am, 1994, 5(2):261-281.
2.	Debatisse D, Pralong E, Dehdashti AR, et al. Simultaneous multilobar electrocorticography (mEcoG) and scalp electroencephalography (scalp EEG) during intracranial vascular surgery:a new approach in neuromonitoring. Clin Neurophysiol, 2005, 116(12):2734-2740.
3.	Minahan RE, Mandir AS. Neurophysiologic intraoperative monitoring of trigeminal and facial nerves. J Clin Neurophysiol, 2011, 28 (6):551-565.
4.	Shedd DP, Durham C. Electrical identification of the recurrent laryngeal nerve. I. Response of the canine larynx to electrical stimulation of the recurrent laryngeal nerve. Ann Surg, 1966, 163(1):47-50.
5.	James AG, Crocker S, Woltering E, et al. A simple method for identifying and testing the recurrent laryngeal nerve. Surg Gynecol Obstet, 1985, 161(2):185-186.
6.	Flisberg K, Lindholm T. Electrical stimulation of the human recurrent laryngeal nerve during thyroid operation. Acta Otolaryngol Suppl, 1969, 263:63-67.
7.	Yarbrough DE, Thompson GB, Kasperbauer JL, et al. Intraoperative electromyographic monitoring of the recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery. Surgery, 2004, 136(6):1107-1115.
8.	Rice DH, Cone-Wesson B. Intraoperative recurrent laryngeal nerve monitoring. Otolaryngol Head Neck Surg, 1991, 105(3):372-375.
9.	Tschopp K, Probst R. New aspects in surgery of the thyroid gland with intraoperative monitoring of the recurrent laryngeal nerve. Laryngorhinootologie, 1994, 73(11):568-572.
10.	Jonas J, B?hr R. Intraoperative neuromonitoring of the recurrent laryngeal nerve results and learning curve. Zentralbl Chir, 2006, 131(6):443-448.
11.	Tschopp KP, Gottardo C. Comparison of various methods of electromyographic monitoring of the recurrent laryngeal nerve in thyroid surgery. Ann Otol Rhinol Laryngol, 2002, 111(9):811-816.
12.	Brauckhoff M, Walls G, Brauckhoff K, et al. Identification of the non-recurrent inferior laryngeal nerve using intraoperative neurostimulation. Langenbecks Arch Surg, 2002, 386(7):482-487.
13.	Eisele DW. Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve. Laryngoscope, 1996, 106(4):443-449.
14.	Horn D, R?tzscher VM. Intraoperative electromyogram monitoring of the recurrent laryngeal nerve:experience with an intralaryngeal surface electrode. A method to reduce the risk of recurrent laryngeal nerve injury during thyroid surgery. Langenbecks Arch Surg, 1999, 384(4):392-395.
15.	Timon CI, Rafferty M. Nerve monitoring in thyroid surgery:is it worthwhile? Clin Otolaryngol Allied Sc, 1999, 24(6):487-490.
16.	Hemmerling TM, Schmidt J, Wolf T, et al. Surface vs intramuscular laryngeal electromyography. Can J Anaesth, 2000, 47(9):860-865.
17.	Lamadé W, Meyding-Lamadé U, Buchhold C, et al. First continuous nerve monitoring in thyroid gland surgery. Chirurg, 2000, 71(5):551-557.
18.	Brennan J, Moore EJ, Shuler KJ. Prospective analysis of the efficacy of continuous intraoperative nerve monitoring during thyroidectomy, parathyroidectomy, and parotidectomy. Otolaryngol Head Neck Surg, 2001, 124(5):537-543.
19.	劉仁斌, Randolph GW, 呂偉明, 等. 喉肌電活動實時監測喉返神經在甲狀腺手術中應用. 中山大學學報:醫學科學版, 2008, 29(6):724-727, 732.
20.	魏濤, 李志輝, 朱精強. 喉返神經探測儀實時監測在再次甲狀腺手術中的應用. 中國普外基礎與臨床雜志, 2010, 17(8):772-774.
21.	Chiang FY, Lee KW, Chen HC, et al. Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation. World J Surg, 2010, 34(2):223-229.
22.	Randolph GW, Dralle H; International Intraoperative Monitoring Study Group, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery:international standards guideline statement. Laryngoscope, 2011, 121 Suppl 1:S1-S16.
23.	中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺及甲狀腺旁腺術中神經電生理監測臨床指南(中國版). 中國實用外科雜志, 2013, 33(6):470-474.
24.	Dioniqi G, Kim HY, Wu CW, et al. Vagus nerve stimulation for standardized monitoring:technical notes for conventional and endoscopic thyroidectomy. Surg Technol Int, 2013, 23:95-103.
25.	Chiang FY, Lu IC, Kuo WR, et al. The mechanism of recurrent laryngeal nerve injury during thyroid surgery-the application of intraoperative neuromonitoring. Surgery, 2008, 143(6):743-749.
26.	Chiang FY, Lu IC, Tsai CJ, et al. Does extensive dissection of recurrent laryngeal nerve during thyroid operation increase the risk of nerve injury? Evidence from the application of intraoperative neuromonitoring. Am J Otolaryngol, 2011, 32(6):499-503.
27.	Lu IC, Tsai CJ, Wu CW, et al. A comparative study between 1 and 2 effective doses of rocuronium for intraoperative neuromonitoring during thyroid surgery. Surgery, 2011, 149(4):543-548.
28.	孫輝, 劉曉莉, 趙濤, 等. 術中神經監測識別非返性喉返神經6例經驗. 中華內分泌外科雜志, 2010, 4(6):402-404.
29.	Brauckhoff M, Machens A, Sekulla C, et al. Latencies shorter than 3.5 ms after vagus nerve stimulation signify a nonrecurrent inferior laryngeal nerve before dissection. Ann Surg, 2011, 253(6):1172-1177.
30.	Brauckhoff M, Naterstad H, Brauckhoff K, et al. Latencies longer than 3.5 ms after vagus nerve stimulation does not exclude a nonrecurrent inferior laryngeal nerve. BMC Surg, 2014, 14:61.
31.	Chiang FY, Lu IC, Tsai CJ, et al. Detecting and identifying nonrecurrent laryngeal nerve with the application of intraoperative neuromonitoring during thyroid and parathyroid operation. Am J Otolaryngol, 2012, 33(1):1-5.
32.	Donatini G, Carnaille B, Dionigi G. Increased detection of non-recurrent inferior laryngeal nerve (NRLN) during thyroid surgery using systematic intraoperative neuromonitoring (IONM). World J Surg, 2013, 37(1):91-93.
33.	Dionigi G, Chiang FY, Rausei S, et al. Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardised intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy. Langenbecks Arch Surg, 2010, 395(7):893-899.
34.	Chiang FY, Lu IC, Chen HC, et al. Anatomical variations of recurrent laryngeal nerve during thyroid surgery:how to identify and handle the variations with intraoperative neuromonitoring. Kaohsiung J Med Sci, 2010, 26(11):575-583.
35.	Dralle H, Sekulla C, Haerting J, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery, 2004, 136(6):1310-1322.
36.	Mangano A, Wu CW, Lianos GD, et al. Evidence-based analysis on the clinical impact of intraoperative neuromonitoring in thyroid surgery:state of the art and future perspectives. Surg Technol Int, 2014, 25:91-96.
37.	孫輝, 劉曉莉, 張大奇, 等. 甲狀腺手術中喉返神經保護及監測的臨床應用. 中國普外基礎與臨床雜志, 2010, 17(8):768-771.
38.	黃澤楠, 黃群愛, 劉宇, 等. 喉返神經實時監測與常規暴露在甲狀腺手術中的比較. 中華臨床醫師雜志, 2013, 7(2):570-574.
39.	羅樂, 崔東旭. 喉返神經監測儀實時監控在甲狀腺術中的應用. 中國醫科大學, 2013.
40.	Zheng S, Xu Z, Wei Y, et al. Effect of intraoperative neuromonitoring on recurrent laryngeal nerve palsy rates after thyroid surgery-a meta-analysis. J Formos Med Assoc, 2013, 112(8):463-472.
41.	Chiang FY, Lu IC, Chen HC, et al. Intraoperative neuromonitoring for early localization and identification of recurrent laryngeal nerve during thyroid surgery. Kaohsiung J Med Sci, 2010, 26(12):633-639.
42.	劉春萍, 黃韜. 甲狀腺手術喉返神經損傷的原因及處理探討. 中國普外基礎與臨床雜志, 2008, 15(5):314-317.
43.	付言濤, 周樂, 張大奇, 等. 非肉眼可見的喉返神經損傷的機制及其預防:術中神經監測系統在甲狀腺手術中的應用. 中華內分泌外科雜志, 2011, 5(4):268-270.
44.	Dionigi G, Alesina PF, Barczynski M, et al. Recurrent laryngeal nerve injury in video-assisted thyroidectomy:lessons learned from neuromonitoring. Surg Endosc, 2012, 26(9):2601-2608.
45.	Wu CW, Dionigi G, Sun H, et al. Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery:a porcine model. Surgery, 2014, 155(2):329-339.
46.	Lee HY, Cho YG, You JY, et al. Traction injury of the recurrent laryngeal nerve:Results of continuous intraoperative neuromonitoring in a swine model. Head Neck, 2014 Dec 9.[Epub ahead of print].
47.	Lamadé W, Ulmer C, Seimer A, et al. A new system for continuous recurrent laryngeal nerve monitoring. Minim Invasive Ther Allied Technol, 2007, 16(3):149-154.
48.	Ulmer C, Koch KP, Seimer A, et al. Real-time monitoring of the recurrent laryngeal nerve:an observational clinical trial. Surgery, 2008, 143(3):359-365.
49.	Schneider R, Przybyl J, Hermann M, et al. A new anchor electrode design for continuous neuromonitoring of the recurrent laryngeal nerve by vagal nerve stimulations. Langenbecks Arch Surg, 2009, 394(5):903-910.
50.	Jonas J. Continuous intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery. Zentralbl Chir, 2010, 135(3):273-276.
51.	Schneider R, Przybyl J, Pliquett U, et al. A new vagal anchor electrode for real-time monitoring of the recurrent laryngeal nerve. Am J Surg, 2010, 199(4):507-514.
52.	Lamadé W, Ulmer C, Rieber F, et al. New backstrap vagus electrode for continuous intraoperative neuromonitoring in thyroid surgery. Surg Innov, 2011, 18(3):206-213.
53.	Van Slycke S, Gillardin JP, Brusselaers N, et al. Initial experience with S-shaped electrode for continuous vagal nerve stimulation in thyroid surgery. Langenbecks Arch Surg, 2013, 398(5):717-722.
54.	Friedrich C, Ulmer C, Rieber F, et al. Safety analysis of vagal nerve stimulation for continuous nerve monitoring during thyroid surgery. Laryngoscope, 2012, 122(9):1979-1987.
55.	Wu CW, Dionigi G, Chen HC, et al. Vagal nerve stimulation without dissecting the carotid sheath during intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery. Head Neck, 2013, 35(10):1443-1447.
56.	Magnus Melin, Katharina Schwarz, Bernhard J, et al. IONM-guided goiter surgery leading to two-stage thyroidectomy——indication and results. Langenbecks Arch Surg, 2013, 398(3):411-418.
57.	Dionigi G, Frattini F. Staged thyroidectomy:time to consider intraoperative neuromonitoring as standard of care. Thyroid, 2013, 23(7):906-908.
58.	Cernea CR, Ferraz AR, Nishio S, et al. Surgical anatomy of the external branch of the superior laryngeal nerve. Head Neck, 1992, 14(5):380-383.
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61.	Jonas J, B?hr R. Neuromonitoring of the external branch of the superior laryngeal nerve during thyroid surgery. Am J Surg, 2000, 179(3):234-236.
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67.	Dionigi G, Bacuzzi A, Barczynski M, et al. Implementation of systematic neuromonitoring training for thyroid surgery. Updates Surg, 2011, 63(3):201-207.

1. ?Chen TC, Rabb C, Apuzzo ML. Complex technical methodologies and their applications in the surgery of intracranial meningiomas. Neurosurg Clin N Am, 1994, 5(2):261-281.
2. Debatisse D, Pralong E, Dehdashti AR, et al. Simultaneous multilobar electrocorticography (mEcoG) and scalp electroencephalography (scalp EEG) during intracranial vascular surgery:a new approach in neuromonitoring. Clin Neurophysiol, 2005, 116(12):2734-2740.
3. Minahan RE, Mandir AS. Neurophysiologic intraoperative monitoring of trigeminal and facial nerves. J Clin Neurophysiol, 2011, 28 (6):551-565.
4. Shedd DP, Durham C. Electrical identification of the recurrent laryngeal nerve. I. Response of the canine larynx to electrical stimulation of the recurrent laryngeal nerve. Ann Surg, 1966, 163(1):47-50.
5. James AG, Crocker S, Woltering E, et al. A simple method for identifying and testing the recurrent laryngeal nerve. Surg Gynecol Obstet, 1985, 161(2):185-186.
6. Flisberg K, Lindholm T. Electrical stimulation of the human recurrent laryngeal nerve during thyroid operation. Acta Otolaryngol Suppl, 1969, 263:63-67.
7. Yarbrough DE, Thompson GB, Kasperbauer JL, et al. Intraoperative electromyographic monitoring of the recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery. Surgery, 2004, 136(6):1107-1115.
8. Rice DH, Cone-Wesson B. Intraoperative recurrent laryngeal nerve monitoring. Otolaryngol Head Neck Surg, 1991, 105(3):372-375.
9. Tschopp K, Probst R. New aspects in surgery of the thyroid gland with intraoperative monitoring of the recurrent laryngeal nerve. Laryngorhinootologie, 1994, 73(11):568-572.
10. Jonas J, B?hr R. Intraoperative neuromonitoring of the recurrent laryngeal nerve results and learning curve. Zentralbl Chir, 2006, 131(6):443-448.
11. Tschopp KP, Gottardo C. Comparison of various methods of electromyographic monitoring of the recurrent laryngeal nerve in thyroid surgery. Ann Otol Rhinol Laryngol, 2002, 111(9):811-816.
12. Brauckhoff M, Walls G, Brauckhoff K, et al. Identification of the non-recurrent inferior laryngeal nerve using intraoperative neurostimulation. Langenbecks Arch Surg, 2002, 386(7):482-487.
13. Eisele DW. Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve. Laryngoscope, 1996, 106(4):443-449.
14. Horn D, R?tzscher VM. Intraoperative electromyogram monitoring of the recurrent laryngeal nerve:experience with an intralaryngeal surface electrode. A method to reduce the risk of recurrent laryngeal nerve injury during thyroid surgery. Langenbecks Arch Surg, 1999, 384(4):392-395.
15. Timon CI, Rafferty M. Nerve monitoring in thyroid surgery:is it worthwhile? Clin Otolaryngol Allied Sc, 1999, 24(6):487-490.
16. Hemmerling TM, Schmidt J, Wolf T, et al. Surface vs intramuscular laryngeal electromyography. Can J Anaesth, 2000, 47(9):860-865.
17. Lamadé W, Meyding-Lamadé U, Buchhold C, et al. First continuous nerve monitoring in thyroid gland surgery. Chirurg, 2000, 71(5):551-557.
18. Brennan J, Moore EJ, Shuler KJ. Prospective analysis of the efficacy of continuous intraoperative nerve monitoring during thyroidectomy, parathyroidectomy, and parotidectomy. Otolaryngol Head Neck Surg, 2001, 124(5):537-543.
19. 劉仁斌, Randolph GW, 呂偉明, 等. 喉肌電活動實時監測喉返神經在甲狀腺手術中應用. 中山大學學報:醫學科學版, 2008, 29(6):724-727, 732.
20. 魏濤, 李志輝, 朱精強. 喉返神經探測儀實時監測在再次甲狀腺手術中的應用. 中國普外基礎與臨床雜志, 2010, 17(8):772-774.
21. Chiang FY, Lee KW, Chen HC, et al. Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation. World J Surg, 2010, 34(2):223-229.
22. Randolph GW, Dralle H; International Intraoperative Monitoring Study Group, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery:international standards guideline statement. Laryngoscope, 2011, 121 Suppl 1:S1-S16.
23. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺及甲狀腺旁腺術中神經電生理監測臨床指南(中國版). 中國實用外科雜志, 2013, 33(6):470-474.
24. Dioniqi G, Kim HY, Wu CW, et al. Vagus nerve stimulation for standardized monitoring:technical notes for conventional and endoscopic thyroidectomy. Surg Technol Int, 2013, 23:95-103.
25. Chiang FY, Lu IC, Kuo WR, et al. The mechanism of recurrent laryngeal nerve injury during thyroid surgery-the application of intraoperative neuromonitoring. Surgery, 2008, 143(6):743-749.
26. Chiang FY, Lu IC, Tsai CJ, et al. Does extensive dissection of recurrent laryngeal nerve during thyroid operation increase the risk of nerve injury? Evidence from the application of intraoperative neuromonitoring. Am J Otolaryngol, 2011, 32(6):499-503.
27. Lu IC, Tsai CJ, Wu CW, et al. A comparative study between 1 and 2 effective doses of rocuronium for intraoperative neuromonitoring during thyroid surgery. Surgery, 2011, 149(4):543-548.
28. 孫輝, 劉曉莉, 趙濤, 等. 術中神經監測識別非返性喉返神經6例經驗. 中華內分泌外科雜志, 2010, 4(6):402-404.
29. Brauckhoff M, Machens A, Sekulla C, et al. Latencies shorter than 3.5 ms after vagus nerve stimulation signify a nonrecurrent inferior laryngeal nerve before dissection. Ann Surg, 2011, 253(6):1172-1177.
30. Brauckhoff M, Naterstad H, Brauckhoff K, et al. Latencies longer than 3.5 ms after vagus nerve stimulation does not exclude a nonrecurrent inferior laryngeal nerve. BMC Surg, 2014, 14:61.
31. Chiang FY, Lu IC, Tsai CJ, et al. Detecting and identifying nonrecurrent laryngeal nerve with the application of intraoperative neuromonitoring during thyroid and parathyroid operation. Am J Otolaryngol, 2012, 33(1):1-5.
32. Donatini G, Carnaille B, Dionigi G. Increased detection of non-recurrent inferior laryngeal nerve (NRLN) during thyroid surgery using systematic intraoperative neuromonitoring (IONM). World J Surg, 2013, 37(1):91-93.
33. Dionigi G, Chiang FY, Rausei S, et al. Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardised intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy. Langenbecks Arch Surg, 2010, 395(7):893-899.
34. Chiang FY, Lu IC, Chen HC, et al. Anatomical variations of recurrent laryngeal nerve during thyroid surgery:how to identify and handle the variations with intraoperative neuromonitoring. Kaohsiung J Med Sci, 2010, 26(11):575-583.
35. Dralle H, Sekulla C, Haerting J, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery, 2004, 136(6):1310-1322.
36. Mangano A, Wu CW, Lianos GD, et al. Evidence-based analysis on the clinical impact of intraoperative neuromonitoring in thyroid surgery:state of the art and future perspectives. Surg Technol Int, 2014, 25:91-96.
37. 孫輝, 劉曉莉, 張大奇, 等. 甲狀腺手術中喉返神經保護及監測的臨床應用. 中國普外基礎與臨床雜志, 2010, 17(8):768-771.
38. 黃澤楠, 黃群愛, 劉宇, 等. 喉返神經實時監測與常規暴露在甲狀腺手術中的比較. 中華臨床醫師雜志, 2013, 7(2):570-574.
39. 羅樂, 崔東旭. 喉返神經監測儀實時監控在甲狀腺術中的應用. 中國醫科大學, 2013.
40. Zheng S, Xu Z, Wei Y, et al. Effect of intraoperative neuromonitoring on recurrent laryngeal nerve palsy rates after thyroid surgery-a meta-analysis. J Formos Med Assoc, 2013, 112(8):463-472.
41. Chiang FY, Lu IC, Chen HC, et al. Intraoperative neuromonitoring for early localization and identification of recurrent laryngeal nerve during thyroid surgery. Kaohsiung J Med Sci, 2010, 26(12):633-639.
42. 劉春萍, 黃韜. 甲狀腺手術喉返神經損傷的原因及處理探討. 中國普外基礎與臨床雜志, 2008, 15(5):314-317.
43. 付言濤, 周樂, 張大奇, 等. 非肉眼可見的喉返神經損傷的機制及其預防:術中神經監測系統在甲狀腺手術中的應用. 中華內分泌外科雜志, 2011, 5(4):268-270.
44. Dionigi G, Alesina PF, Barczynski M, et al. Recurrent laryngeal nerve injury in video-assisted thyroidectomy:lessons learned from neuromonitoring. Surg Endosc, 2012, 26(9):2601-2608.
45. Wu CW, Dionigi G, Sun H, et al. Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery:a porcine model. Surgery, 2014, 155(2):329-339.
46. Lee HY, Cho YG, You JY, et al. Traction injury of the recurrent laryngeal nerve:Results of continuous intraoperative neuromonitoring in a swine model. Head Neck, 2014 Dec 9.[Epub ahead of print].
47. Lamadé W, Ulmer C, Seimer A, et al. A new system for continuous recurrent laryngeal nerve monitoring. Minim Invasive Ther Allied Technol, 2007, 16(3):149-154.
48. Ulmer C, Koch KP, Seimer A, et al. Real-time monitoring of the recurrent laryngeal nerve:an observational clinical trial. Surgery, 2008, 143(3):359-365.
49. Schneider R, Przybyl J, Hermann M, et al. A new anchor electrode design for continuous neuromonitoring of the recurrent laryngeal nerve by vagal nerve stimulations. Langenbecks Arch Surg, 2009, 394(5):903-910.
50. Jonas J. Continuous intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery. Zentralbl Chir, 2010, 135(3):273-276.
51. Schneider R, Przybyl J, Pliquett U, et al. A new vagal anchor electrode for real-time monitoring of the recurrent laryngeal nerve. Am J Surg, 2010, 199(4):507-514.
52. Lamadé W, Ulmer C, Rieber F, et al. New backstrap vagus electrode for continuous intraoperative neuromonitoring in thyroid surgery. Surg Innov, 2011, 18(3):206-213.
53. Van Slycke S, Gillardin JP, Brusselaers N, et al. Initial experience with S-shaped electrode for continuous vagal nerve stimulation in thyroid surgery. Langenbecks Arch Surg, 2013, 398(5):717-722.
54. Friedrich C, Ulmer C, Rieber F, et al. Safety analysis of vagal nerve stimulation for continuous nerve monitoring during thyroid surgery. Laryngoscope, 2012, 122(9):1979-1987.
55. Wu CW, Dionigi G, Chen HC, et al. Vagal nerve stimulation without dissecting the carotid sheath during intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery. Head Neck, 2013, 35(10):1443-1447.
56. Magnus Melin, Katharina Schwarz, Bernhard J, et al. IONM-guided goiter surgery leading to two-stage thyroidectomy——indication and results. Langenbecks Arch Surg, 2013, 398(3):411-418.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Advances in Intraoperative Neuromonitoring During Thyroid or Parathyroid Surgery

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