Continuous intraoperative neuromonitoring of the recurrent laryngeal nerve during lung operations

Background: The recurrent laryngeal nerve (RLN), especially on the left side, is particularly vulnerable during lung operations. Therefore, continuous intraoperative neuromonitoring (cIONM) would be desirable. With the use of a double-lumen tube (DLT) for single-lung ventilation, there is some uncertainty where the recording electrode should be positioned. The aim of this study was to assess the feasibility of this technique and to predict the ideal position of a single recording electrode. Methods: Patients scheduled to undergo left thoracotomy due to pulmonary pathologies, two adhesive electrodes were affixed consecutively above the proximal cuff of the DLT prior to intubation for a precise location of the recording from the vocal cords. Following thoracotomy, the vagus nerve alongside the aortic arch was exposed. A continuous stimulation probe (Saxophone((R)) electrode, Dr. Langer Medical, Waldkirch, Germany) was placed around the nerve. The signals of the respective electrode were recorded and analyzed with regard to previously defined limits of positive signaling. Results: Strong signals with an amplitude of at least 165 mu V were recorded in 18 of 20 patients. In these patients 100% of the signals were recorded via the distally located electrode. An additional signal was recorded via the proximal electrode in four patients. cIONM was found to be a safe and reproducible technique. Conclusions: The described technique enables the use of cIONM of the RLN throughout the entire course of the surgical procedure.