Feasibility of Continuous Intraoperative Neural Monitoring During Transoral Endoscopic Thyroidectomy Vestibular Approach in a Porcine Model

Background: Experimental study to evaluate feasibility of continuous intraoperative neural monitoring (C-IONM) in transoral endoscopic thyroidectomy vestibular approach (TOETVA). Methods: Duroc-Landrace pigs were orally intubated with electromyogram endotracheal tube. Automatic periodic stimulation (APS) electrode was allocated in the operative field through the 5-mm ports. APS was then repose on vagal nerve (VN) with different approaches: (1) median, that is, between sternothyroid and thyroid gland; and (2) lateral, that is, between sternocleidomastoid and sternothyroid. VN was stimulated proximally and distally to the APS location to verify whether the dissection and/or placement determined VN injury. Video presentation is offered. Results: Assembled APS accessory was feasible in large-brained animals. The two basic options for VN approaches were tested. Baseline obtained had amplitude values >1000V, bilaterally. Conclusions: C-IONM was feasible in TOETVA in porcine models, but simplification of electrode design and application is needed.