Παρότι η τεχνολογία αυτή είναι διαθέσιμη εδώ και χρόνια, δεν θεωρείται αυτονόητη σε όλα τα νοσοκομεία. Όταν διορίστηκα στο Πανεπιστημιακό Νοσοκομείο Ιωαννίνων το 2019, χρειάστηκε ιδιαίτερη προσπάθεια για να πειστεί η τότε διοίκηση για την αξία της. Σήμερα, χάρη σε εκείνη την πρωτοβουλία, η Neuromonitoring χρησιμοποιείται συστηματικά από όλους τους χειρουργούς του Πανεπιστημιακού Νοσοκομείου, τόσο για τη θυρεοειδεκτομή όσο και για την παρωτιδεκτομή, την υπογναθεκτομή και τον τραχηλικό λεμφαδενικό καθαρισμό

How does neuromonitoring work?

This method is based on the placement of special electrodes —usually through a special cannulation tube— which record the slightest movement of the vocal cords when we stimulate the nerve. The recording is done both visually and audibly, allowing us to confirm in real time that the nerve is responding normally and the vocal cords are functioning.

This technology is particularly useful in cases of anatomical variations, where the recurrent laryngeal nerve has an unusual course and is more prone to injury. In such cases, the use of neurostimulation provides us with critical information that guides our movements with greater precision and safety.

What does the international literature say?

Although there is debate in the literature about the absolute effectiveness of the method, the conclusion is clear: Careful nerve identification and preparation with the aid of neuromonitoring is currently the “gold standard” for injury prevention. Neuromonitoring does not replace proper surgical technique—it enhances it.

Our surgical approach

In most cases, we first locate the vagus nerve (which has a fixed anatomical location), and stimulate it to ensure that the recording system is functioning properly. We then look for the recurrent laryngeal nerve and proceed with its careful release and protection. After the lobe removal is complete, re-stimulation of the vagus nerve assures us that the vocal cord has mobility and we can safely proceed to the second thyroid lobe.

Continuous Vagal Stimulation (C-IONM)

In more complex procedures or in patients with extensive disease, we apply continuous monitoring of the vagus nerve through the Continuous Vagal Stimulation systemA special small sensor is placed on the nerve and sends signals every second. If a drop in signal intensity is detected, the surgeon can react immediately, e.g. temporarily interrupt or change tactics, preventing a possible injury.

This technology offers significant advantages and requires good training, which Mr. Psychogios has received during his tenure at the Erlangen University Clinic.

In any case, the proper functioning of the vocal cords is confirmed after surgery with laryngoscopy of the patient, even in cases where there is no hoarseness.