Automated Periodic Stimulation Electrode Installation: A Technique to Surgically Implant An Automated Stimulation Device on the Vagus Nerve in a Porcine Model

The vagus nerve, or VN, is the longest cranial nerve that innervates significant regions of the body, including the laryngeal muscles. Frequently, thyroid operations cause injury to the vagus nerve in the larynx, leading to loss of function.

To identify the vagus nerve, prepare an anesthetized pig intubated with an electromyography, or EMG, tube. An EMG tube is a device that aids in monitoring the electrical activity of the laryngeal musculature and provides an open airway for ventilation.

Disinfect the neck region and make a long transverse collar incision to expose the larynx. Lift the skin flap from the collarbone to the U-shaped bone in the midline region of the neck. Dissect the underlying muscles to expose the trachea and nerves.

Using a stimulation probe, briefly deliver electrical impulses to the nerves. Upon stimulation, sodium channels in the cell membrane open and sodium ions enter the cell, depolarizing the membrane. The resulting muscle response is recorded via EMG tube. This enables the identification of the nerve location and its functional status.

Once the vagus nerve is identified, incise the connective tissue layer and use forceps to clip the automated periodic stimulation, or APS electrode around it and connect it to the monitoring system. The APS electrode provides continuous low-level stimulation to the vagus nerve and records the subsequent electromyographic response.