Book chapter
Troubleshooting System Integrity
Intraoperative Cranial Nerve Monitoring in Otolaryngology-Head and Neck Surgery, pp.107-115
Springer International Publishing
01/03/2022
DOI: 10.1007/978-3-030-84916-0_11
Abstract
Intraoperative monitoring of the recurrent laryngeal nerve (RLN) during thyroid and parathyroid surgery has become increasingly widespread. Technical difficulties with nerve monitoring systems have been a source of frustration since their earliest use and can limit their usefulness in preventing nerve injury. In this chapter, we present a brief summary of the primary mechanism of RLN injury and practice patterns for RLN monitoring, provide a framework for understanding the system as a circuit, and outline a systematic approach to intraoperative troubleshooting of the monitoring system. We present a set of suggestions for the scenario in which there is a loss of signal when stimulating over a visible RLN, as well as suggestions for dealing with excess noise or continuous unanticipated signal. These algorithmic flowcharts are organized such that the most common and the most easily addressable factors are addressed first before less likely problems and potentially more disruptive maneuvers are tried. In following these suggestions, the surgeon and operating room staff may systematically adjust any patient-related factors or correct errors with the system before concluding that potential harm has been done to the nerve and considering the expedience of a staged surgery. Routine use of intraoperative RLN monitoring coupled with practice in systematic troubleshooting has the potential to enhance surgical safety and efficacy.
Details
- Title: Subtitle
- Troubleshooting System Integrity
- Creators
- Douglas M. Bennion - University of IowaNitin A. Pagedar - University of Iowa
- Resource Type
- Book chapter
- Publication Details
- Intraoperative Cranial Nerve Monitoring in Otolaryngology-Head and Neck Surgery, pp.107-115
- DOI
- 10.1007/978-3-030-84916-0_11
- Publisher
- Springer International Publishing; Cham
- Language
- English
- Date published
- 01/03/2022
- Academic Unit
- Otolaryngology
- Record Identifier
- 9984314087902771
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