Intraoperative Neuromonitoring of Recurrent Laryngeal Nerve During Thyroidectomy with Adhesive Skin Electrodes

  • Hyoung Shin Lee
  • Jungho Oh
  • Sung Won Kim
  • Yeong Wook Jeong
  • Che-Wei Wu
  • Feng-Yu Chiang
  • Kang Dae LeeEmail author
Original Scientific Report



Alternative methods to overcome limitations of electromyogram (EMG) tube applied for intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) during thyroidectomy have been introduced. In this study, we evaluated the feasibility of adhesive skin electrodes for IONM of RLN in patients who underwent thyroidectomy.


A total of 39 nerves at risk were prospectively enrolled in this study. Twenty-five patients with papillary thyroid carcinoma, 3 patients with follicular neoplasm, and 2 patients with Graves’ disease underwent thyroidectomy. All patients were intubated with EMG tube, and two disposable pre-gelled surface electrodes were attached to skin at both upper margins of thyroid cartilage. We followed the standard procedure of IONM, and the latency (msec) and amplitude (μV) of each signal were recorded prospectively.


Intraoperative neuromonitoring using skin adhesive electrodes was successful in all nerves at risk. Amplitudes of the signals in IONM were significantly lower compared to those from EMG tube at each step of IONM, while no significant difference was identified in latency between two methods. Four nerves at risk (10.3%) showed loss of signal (<100 μV) during the steps of IONM from EMG tube, while all nerves at risk from adhesive skin electrodes showed acceptable biphasic EMG signal.


We verified the usefulness of adhesive skin electrodes for IONM of RLN during thyroidectomy. Although lower amplitude remains the major limitation of this technique, adhesive skin electrodes may be considered an alternative method for IONM during thyroidectomy.



This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2017R1D1A1B03031082, 2018R1D1A1B07045831).

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.

Informed consent

All patients gave their informed consent for this study and IONM, and the institutional review board of our center admitted this study (IRB No. 2018–11-022).


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Hyoung Shin Lee
    • 1
  • Jungho Oh
    • 2
  • Sung Won Kim
    • 1
  • Yeong Wook Jeong
    • 1
  • Che-Wei Wu
    • 3
  • Feng-Yu Chiang
    • 3
  • Kang Dae Lee
    • 1
    Email author
  1. 1.Department of Otolaryngology-Head and Neck SurgeryKosin University College of MedicineBusanRepublic of Korea
  2. 2.Department of Otolaryngology-Head and Neck SurgeryHaedong HospitalBusanRepublic of Korea
  3. 3.Department of Otolaryngology-Head and Neck SurgeryKaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan

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