Name: investigation of the electrophysiological and thermographic safety parameters of surgical energy devices during thyroid and parathyroid surgery in a porcine model
Uploaded: 2022-10-13T13:00:00
Duration: 11 min 46 s
Description: Watch this Scientific Journal Video about Investigation of the Electrophysiological and Thermographic Safety Parameters of Surgical Energy Devices During Thyroid and Parathyroid Surgery in a Porcine M

This study was supported by grants from Kaohsiung Medical University Hospital, Kaohsiung Medical University (KMUH109-9M44), Kaohsiung Municipal Siaogang Hospital/Kaohsiung Medical University Research Center grants (KMHK-DK(C)110009, I-109-04, H-109-05, I-108-02), and Ministry of Science and Technology (MOST 109-2628-B-037-014, MOST 110-2314-B-037-104-MY2, MOST 110-2314-B-037-120), Taiwan.

The animal experiments were approved by the Institutional Animal Care and Use Committee (IACUC) of Kaohsiung Medical University, Taiwan (protocol no: IACUC-110082).
1. Animal preparation and anesthesia
<ol>
	<li>Conditions for porcine selection: Select Duroc-Landrace pigs at age of 3 to 4 months old and weighing 18 to 30 kg.</li>
	<li>Preparation before the experiment: Fast the pigs for 8 h without food and 2 h without water before anesthesia.</li>
	<li>Anesthesia induction: Administer 2 mg/kg Tiletamine/Zolazepam via intramuscular route 30 min before surgery 
	NOTE: Neuromuscular block agents were not used during anesthesia induction.</li>
	<li>Endotracheal tube selection: Use a 6.0 mm commercial electromyography (EMG) endotracheal tube (the recording electrodes) in the manner routinely used clinically.</li>
	<li>Intubation: Let the anesthesiologist intubate the recording electrodes with the assistance of direct laryngoscopy in the prone position. In this study, the endotracheal tube was fixed at 24 cm through end-tidal carbon dioxide (etCO2) monitoring and chest auscultation to ensure the appropriate tube location.</li>
	<li>Anesthesia maintenance: Position the pig on its back, extend the neck, and fix the endotracheal tube. Set the tidal volume to 8 to 12 mL/kg and a 15 to 20 breaths per minute respiratory rate. Use 1% to 2% sevoflurane for general anesthesia maintenance. 
	&#8203;NOTE: Neuromuscular block agents were not used during anesthesia maintenance.</li>
	<li>During the experiment, in addition to continuous monitoring of the animal&#39;s core body temperature, it is important to ensure that the experimental temperature is within an appropriate range. If the animal experiences a drop in body temperature, immediate thermal support such as a warm blanket should be provided.</li>
</ol>
2. Animal operation (Figure 1 and Figure 2)
<ol>
	<li>Verify a surgical plane of anesthesia.</li>
	<li>Skin incision: Make a 15 cm transverse cervical incision on the skin 1 cm above the sternum (Figure 1A).</li>
	<li>Raise the subplastysmal flap to the hyoid bone level.</li>
	<li>Separate the strap muscles via the midline approach, and retract laterally to visualize the thyroid cartilage, cricoid cartilage, tracheal rings, and thyroid gland. 
	NOTE: The edges of the strap muscles need to be dissected carefully and neatly for TG studies.</li>
	<li>After exposure, dissect the sternocleidomastoid muscles (SCMs) bilaterally (Figure 1B). 
	NOTE: The edges of the SCMs need to be dissected carefully and neatly for EP studies.</li>
	<li>Identify, expose, and dissect along the recurrent laryngeal nerves (RLNs) and vagus nerves (VNs) bilaterally (Figure 2). 
	NOTE: IONM can assist with this step.</li>
	<li>Perform the experiments of EP and TG studies following step 4 and step 5.</li>
	<li>After completing the whole experiment, keep the piglets under 4%-6% sevoflurane and humanely euthanize them by an overdose of Tiletamine/Zolazepam (6 mg/kg).</li>
</ol>
3. Surgical energy devices (SEDs) information and settings
<ol>
	<li>For the details regarding SEDs refer to the Table of Materials. 
	&#8203;NOTE: This study uses Advanced bipolar SEDs (referenced as Device A) to demonstrate the EP and TG studies.</li>
</ol>
4. Electrophysiological (EP) study
<ol>
	<li>Continuous IONM setting (Figure 3) 
	NOTE: Ensure that the recording electrodes are intubated as mentioned in step 1.5.
	<ol>
		<li>Install the ground electrodes outside the surgical incision wound.</li>
		<li>Install the stimulating electrodes: Install a 2.0 mm automatic periodic stimulation (APS) electrode on one side of the VN.</li>
		<li>Connect all electrodes on the interconnection box, and check that the interconnection box is connected to the monitoring system (Nerve Integrity Monitoring system) and that the power of the monitoring system is on (Figure 3A).</li>
		<li>Confirm that the monitoring system shows that the electrodes are connected correctly.</li>
		<li>Select the Monitoring page, and click on Advanced Settings.</li>
		<li>Click APS to set APS Stimulation to 1/min for slow rate, 1/s for fast rate, and Alarm Limits to 50% and 2000 &#181;V for amplitudes, 10% for latency. Then click on OK to finish the settings. 
		NOTE: The setting of other columns depends on the experimenter.</li>
		<li>Click on Events Capture in the Events column, and set the event threshold at 100 &#181;V. 
		NOTE: Figure 3B demonstrates the protocol steps 4.1.5-4.1.7.</li>
		<li>Find the Vagus APS Stim column, and set the current of stimulation at 1.0 mA. Click on Baseline; a new window, Establishing APS Baseline, will appear on the right side of the screen.</li>
		<li>Input the Session Title and Session Comments. Select the channel to be tested, and the system will automatically start to measure 20 times. The baseline amplitude and latency will be automatically calculated and shown. Click on Accept if the baseline is correct. 
		NOTE: Figure 3C demonstrates the protocol steps 4.1.8-4.1.9.</li>
		<li>Click on the Fast Forward icon in Vagus APS Stim column to start a test. After each EP experiment, click on the Pulse icon to stop recordings.</li>
		<li>Select the Reports page and set the report output format to save the file to USB. 
		NOTE: The sample C-IONM report is shown in Figure 3D.</li>
	</ol>
	</li>
	<li>EP activation study (Figure 4)
	<ol>
		<li>Develop experimental guidelines before starting an experiment. 
		NOTE: Figure 4A shows a common EP activation study protocol example, which can be adjusted according to SED characteristics. For some instruments with activation cycles, the single activation time is a single activation cycle, mostly ranging from 2-4 s. Most SEDs do not have an activation cycle, and the single activation time is 3 s.</li>
		<li>Activation distance tests at 5 mm:
		<ol>
			<li>Apply the SED on the soft tissue at a distance of 5 mm from the RLN and activate SED (single activation).</li>
			<li>Observe the EMG change. Operate at the same activation distance three times unless a substantial EMG amplitude change occurs. 
			NOTE: Figure 4B shows the activation distance test at 5 mm.</li>
		</ol>
		</li>
		<li>Activation distance tests at 2 mm:
		<ol>
			<li>Apply the SED on the soft tissue close to the RLN at 1 mm distance and activate SED (single activation).</li>
			<li>Observe the EMG change. Operate at the same activation distance three times unless a substantial EMG amplitude change occurs.</li>
		</ol>
		</li>
		<li>Activation distance tests at 1 mm:
		<ol>
			<li>Apply the SED on the soft tissue at a distance of 1 mm from the RLN, and activate SED (single activation).</li>
			<li>Observe the EMG change. Operate at the same activation distance three times unless a substantial EMG amplitude change occurs</li>
		</ol>
		</li>
		<li>If a substantial decrease of EMG amplitude is observed during steps 4.2.2-4.2.4, stop the RLN experiment. Record the real-time EMG continuously for 20-60 min to determine whether the injury is reversible. (Figure 4C)</li>
		<li>Manually record the experimental results as a table (Table 1).</li>
	</ol>
	</li>
	<li>EP cooling study (Figure 5)
	<ol>
		<li>Develop experimental guidelines before starting an experiment. 
		NOTE: Figure 5A shows a common EP cooling study protocol example, which can be adjusted according to SED characteristics.</li>
		<li>Cooling time tests of 5 s:
		<ol>
			<li>Apply SED single activation to the SCM muscle. Touch the RLN with the tip of the SED after 5 s of waiting and cooling.</li>
			<li>Observe the EMG change. Operate at the same cooling time three times unless a substantial EMG amplitude change occurs.</li>
		</ol>
		</li>
		<li>Cooling time tests of 2 s:
		<ol>
			<li>Apply SED single activation to the SCM muscle. Touch the RLN with the tip of the SED after 2 s of waiting and cooling.</li>
			<li>Observe the EMG change. Operate at the same cooling time three times unless a substantial EMG amplitude change occurs. 
			NOTE: Figure 5B shows the cooling time test of 2 s.</li>
		</ol>
		</li>
		<li>Proceed immediately with muscle touch maneuver (MTM) tests:
		<ol>
			<li>Apply SED single activation to the SCM muscle. Quickly touch (approximately 1 s) the activated surface of the SED with another position of the SCM (MTM, Figure 5C).</li>
			<li>Touch the RLN with the tip of the SED immediately after MTM and observe the EMG change. Operate at the same cooling time three times unless a substantial EMG amplitude change occurs.</li>
		</ol>
		</li>
		<li>Proceed immediately without muscle touch maneuver (MTM) tests:
		<ol>
			<li>Apply SED single activation to the SCM muscle. Touch the RLN with the tip of the SED immediately without MTM.</li>
			<li>Observe the EMG change. Operate the same cooling time three times unless a substantial EMG amplitude change occurs. If a substantial decrease of EMG amplitude is observed, follow step 4.3.6.</li>
		</ol>
		</li>
		<li>If a substantial decrease of EMG amplitude is observed, stop the RLN experiment. Then, continuously monitor the real-time EMG response for at least 20 min to determine whether the RLN injury is reversible or not. (Figure 5D)</li>
		<li>Manually record the experimental results as a table (Table 2).</li>
	</ol>
	</li>
</ol>
5. Thermographic (TG) study
<ol>
	<li>Set up the thermal imaging system (Figure 6). 
	NOTE: Thermal imaging camera with temperature sensitivity up to a temperature range of -20 &#176;C to 650 &#176;C. The image is updated every second.
	<ol>
		<li>Place the camera 50 cm from the target tissue at an angle of 60&#176; from the experimental table (Figure 6A). 
		NOTE: In the operating field, measured by a thermal imaging camera, the temperature is displayed according to the color scale. The location with the highest temperature on the screen is marked with a &#34;+&#34; sign, and its corresponding temperature is displayed (Figure 6B)</li>
		<li>Select Video Mode, and press the capture button. 
		NOTE: The procedures monitored by the thermal camera are continuously recorded in video form.</li>
	</ol>
	</li>
	<li>Conduct the animal preparation for the TG study:
	<ol>
		<li>Record the background temperature of the experimental area using the thermal imaging camera. The background temperature should be in the range of 25 &#177; 2 &#176;C (Figure 6C). If the background temperature exceeds this range, adjust the temperature of the laboratory air conditioner and test again.</li>
		<li>Standard strap muscle thickness for SED activation: Prepare the strap muscles for the TG study as described in step 2.3. The standard strap muscle thickness for SED activation is 5 mm (Figure 6D).</li>
	</ol>
	</li>
	<li>TG activation study (Figure 6 and Figure 7)
	<ol>
		<li>Dry environment tests: Wipe the surface of porcine strap muscles with dry gauze.
		<ol>
			<li>Whole blade tests in a dry environment (Figure 7A):
			<ol>
				<li>Grasp the strap muscle at the full length of the blade using SED (Figure 6E).</li>
				<li>Evaluate maximum activation temperature: After a single activation, the maximum temperature is shown on the screen during the measurement (Figure 7B).</li>
				<li>Evaluate lateral thermal spread: Measure the diameter of the 60 &#176;C isothermal line after a single activation.</li>
				<li>Evaluate smoke and splashing: After a single activation, when the highest temperature on the screen exceeds 60 &#176;C, record any smoke and splash on the screen. Repeat five measurements in different areas. 
				NOTE: Maximum activation temperature was evaluated with whole blade tests in a dry environment only.</li>
			</ol>
			</li>
			<li>One-third (1/3) of blade tests in a dry environment (Figure 7C):
			<ol>
				<li>Grasp the strap muscle with an anterior 1/3-length blade using SED (Figure 6F). Evaluate the lateral thermal spread, smoke, and splashing (Figure 7D) as described in step 5.3.1.1. Repeat five measurements in different areas.</li>
			</ol>
			</li>
		</ol>
		</li>
		<li>Wet environment tests: Soak the porcine strap muscles in sterile water for 3 s just before SED activation.
		<ol>
			<li>Whole blade tests in a wet environment (Figure 7E): Grasp the strap muscle at full length of the blade using SED and evaluate the lateral thermal spread (Figure 7F), smoke, and splashing as described in step 5.3.1.1. Repeat five measurements in different areas.</li>
			<li>One-third (1/3) tests in a wet environment (Figure 7G): Grasp the strap muscle with an anterior 1/3-length blade using SED and evaluate the lateral thermal spread, smoke (Figure 7H), and splashing as described in step 5.3.1.1. Repeat five measurements at different areas.</li>
		</ol>
		</li>
		<li>Manually record the experimental results as a table (Table 3).</li>
	</ol>
	</li>
	<li>TG cooling study (Figure 8)
	<ol>
		<li>Dry environment: Wipe the surface of porcine strap muscles with dry gauze as in step 5.3.1. 
		NOTE: In the TG cooling study, all activations were performed in a dry environment with whole blade activation.</li>
		<li>Evaluate minimum cooling time without MTM: After SED single activation with the whole blade on strap muscle, start recording the cooling time until the highest temperature on the screen was less than 60 &#176;C. Repeat five measurements in different areas. 
		NOTE: When measuring the cooling time and temperature of the SED blade after single activation and MTM, cover the SED-activated muscle area and the MTM-contacting muscle area with gauze, as the high temperature in these areas will be detected up on the TG screen and interfere with the temperature that is to be actually measured.</li>
		<li>Evaluate the blade temperature after MTM: After a single activation of the SED with the whole blade on the strap muscle, quickly touch (~1 s) the activated surface of the SED with another position of the strap muscle (Figure 8A). Then record its temperature immediately after leaving the SED from the strap muscle with the blade open (Figure 8B).</li>
		<li>Evaluate the minimum cooling time with MTM: After step 5.4.3, when the temperature is more than 60 &#176;C, start recording the cooling time until the highest temperature on the screen is less than 60 &#176;C. Repeat five measurements in different areas.</li>
		<li>Manually record the experimental results as a table (Table 4).</li>
	</ol>
	</li>
</ol>
6. Data interpretations
<ol>
	<li>Present the EP and TG safety parameters in table form with smoke and splashing marked. 
	NOTE: Here, the EP and TG safety parameters of SED are presented in table form, and smoke and splashing are marked with * and # symbols, respectively. In EP and TG studies, the final result lists the maximum data as in Table 5.</li>
</ol>

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The development of SEDs is based on the expectation of thyroid surgeons to achieve effective hemostasis during thyroid surgery. However, the high temperature generated by SED is a risk factor that cannot be ignored. As the use of SED becomes more common, thermal injury to nerves will also become more common. Therefore, it is the responsibility of the thyroid surgeons who use SED to understand how to safely operate the equipment. However, it is not advisable to verify safety parameters through trial and error repeatedly in humans; therefore, the value of animal experiments has been shown. In addition, a standardized process is necessary to qualify and quantify the possible thermal effects of SEDs15,17 to maximally provide thyroid surgeons with guidelines to safely perform operations.
In this study, several steps require more attention. In the EP studies, neuromuscular blockade agents could interfere with EMG signals during neural monitoring and were not used during anesthesia induction and maintenance. In the TG studies, heat sources other than the SED tests should be removed. When the heat sources cannot be removed (e.g., the activation area for cooling study or strap muscle after MTM), it is necessary to block the non-tested heat sources with gauze. In the TG studies, the temperature of SEDs before activation should be confirmed to be within the background reference temperature (25 &#177; 2 &#176;C), otherwise, a cooling measure should be taken, and the blade should be determined to be dry before starting the experiment.
Several previous studies have contributed to the definition of EP15,37,38,39,40,41,42,43&#160;and TG31,32&#160;safety parameters of various SEDs in activation and cooling studies in various porcine thyroid surgery models. The current protocol not only integrates past experience but also further optimizes and standardizes the process. In the EP study, once SED was activated without a safe critical distance or safe cooling time, the nerves faced irreversible and rapid injury. In the TG study, we observed the 60 &#176;C isothermal field and the production of smoke/splashing. Surgeons can better understand the thermal spread patterns in different activation environments and different grasping ranges.
This study still has a few limitations. First, the temperature in the environment is not the same as in the surgical room, and the temperature of the piglet is not the same as the body temperature of a human. Second, the results of the porcine model may not be applicable to all human clinical practices; the animal experimental study not only provides surgeons with SED information that cannot be obtained from humans but also serves as a valuable research platform to establish thermal injury information for newly developed SEDs in the future. This information can help surgeons choose instruments and surgical strategies that can reduce thermal injury during thyroid and parathyroid surgery.
This article demonstrates the standard procedure for using animal experiments so that thyroid surgeons can gain a more comprehensive understanding of (1) the safe activation distance and cooling time for SEDs, (2) the maximum temperature generated by SEDs activation, and (3) irregular lateral thermal spread and smoke/splashing, which may potentially injure the nerve.

Efficient hemostasis is a very important issue in thyroid and parathyroid surgery. In recent decades, one of the most major advances in thyroid and parathyroid surgery has been the development of surgical energy devices (SEDs)1. SEDs provide more efficient hemostasis than the conventional clamp-and-tie technique in areas with rich blood supply, which reduces intraoperative blood loss and operation time2, postoperative hypocalcemia3, and life-threatening postoperative hematoma4. SEDs are reported to be used in 65.7% of thyroidectomy patients in recent studies5, and the annual use of SED increases each year.
However, SEDs have not been proven superior to conventional techniques in terms of recurrent laryngeal nerve (RLN) injury in thyroid and parathyroid surgery4,6,7. Thermal injury and lateral thermal spread to the RLN often occur unexpectedly when a SED is activated near the nerve, and this type of injury is usually severe and irreversible. Compared to mechanical traction or compression nerve injury, thermally nerve injury has less distortion of the outer structure but more severe damage to the inner endoneurium, including the myelin sheath and the axon8,9,10,11. This kind of injury not only experiences difficulty in regaining normal function but also is less reversible in clinical sequence than traction injury10,12. In addition, thermal injury is often invisible to the surgeon and may be unrecognized in the course of surgery13,14. Thus, surgeons should consider the thermal effects of SED to avoid RLN thermal injury during thyroid and parathyroid surgery.
Porcine models are most commonly used for RLN research because the anatomy and physiology of pigs are very similar to those of humans15,16,17,18,19,20. The experimental porcine model enables easy handling, is widely available, and is cost-effective9. For electrophysiological (EP) information, intraoperative neuromonitoring (IONM) is helpful for detecting mechanisms of nerve injury and predicting postoperative vocal cord function21,22,23,24,25,26,27. Addirionally, continuous IONM (CIONM) enables early detection of nerve injury after high-risk procedures because it can immediately feedback for the nerve function by using repetitive vagal stimulation28,29,30. Studies on EP activation and cooling can determine the safe SED activation distance from the RLN and the safe cooling time after SED activation before contacting the RLN. For thermographic&#160;information, a thermal imaging camera is helpful to evaluate the temperature change (activation and cooling), and the hyperthermal region can be visualized after SED activations31,32,33,34,35. In a previous study, RLN thermal injury occurred when the tissue temperature reached the critical temperature of 60 &#176;C in the porcine CIONM model36. Studies on TG activation and cooling can determine the lateral thermal spread distance, the occurrence of smoke and splashing, and the temperature change during cooling with or without the muscle touch maneuver (MTM). To safely apply SED in thyroid/parathyroid surgery, this article introduces an experimental porcine model study to investigate EP and TG safety parameters of SEDs under standardized procedures.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Automatic periodic stimulation (APS)</td>
			<td>Medtronic, Jacksonville, FL</td>
			<td></td>
			<td>2.0 mm</td>
		</tr>
		<tr>
			<td>Advanced bipolar surgical energy devices(SEDs)</td>
			<td>Medtronic, Minneapolis, MN</td>
			<td>LigaSure Exact Dissector (Device A)</td>
			<td>Generator: Valleylab LS10 energy platform 
			Power setting: Default</td>
		</tr>
		<tr>
			<td>Bipolar electrocautery</td>
			<td></td>
			<td></td>
			<td>Generator: ForceTriad energy platform 
			Power setting: 30 watts</td>
		</tr>
		<tr>
			<td>Duroc-Landrace pigs</td>
			<td></td>
			<td></td>
			<td>3&#8211;4 months old; weighing 18&#8211;30 kg</td>
		</tr>
		<tr>
			<td>Electromyography (EMG) Endotracheal tube (ETT)</td>
			<td>Medtronic, Jacksonville, FL</td>
			<td>#6 NIM Standard Tube&#160;</td>
			<td>Recording electrodes</td>
		</tr>
		<tr>
			<td>Ferromagnetic SEDs</td>
			<td>Domain Surgical, Salt Lake City, Utah</td>
			<td>FMwand, and Fmsealer</td>
			<td>Generator: FMX G1 Generator 
			Power setting: FMwand (Max 45); FMsealer (Max 3)</td>
		</tr>
		<tr>
			<td>Hybrid SEDs 
			(Ultrasonic and Advance bipolar SEDs)</td>
			<td>Olympus Co Inc, Tokyo, Japan</td>
			<td>Thunderbeat</td>
			<td>Generator: Thunderbeat generator ESG USG 400 
			Power setting: SEAL&#38;CUT mode (Level 1); SEAL mode (Level 3)</td>
		</tr>
		<tr>
			<td>Monopolar electrocautery&#160;</td>
			<td></td>
			<td></td>
			<td>Generator: ForceTriad energy platform 
			Power setting: 15 watts</td>
		</tr>
		<tr>
			<td>Nerve Integrity Monitoring (NIM) system&#160;</td>
			<td>Medtronic, Jacksonville, FL</td>
			<td>NIM 3.0&#160;</td>
			<td>Intraoperative neuromonitoring (IONM) equipment</td>
		</tr>
		<tr>
			<td>Sevoflurane</td>
			<td></td>
			<td></td>
			<td>1% to 2% for anesthesia maintenance</td>
		</tr>
		<tr>
			<td>Tiletamine/Zolazepam</td>
			<td></td>
			<td></td>
			<td>2 mg/kg for anesthesia induction</td>
		</tr>
		<tr>
			<td>Thermal imaging camera</td>
			<td>Ezo Corp., Taiwan</td>
			<td>Thermal camera D4A (384x288 pixels)</td>
			<td>Thermal image recording equioments</td>
		</tr>
		<tr>
			<td>Ultrasonic SEDs</td>
			<td>Ethicon, Johnson and Johnson, Cincinnati, OH</td>
			<td>Harmonic Focus+</td>
			<td>Generator: Ethicon Endo-Surgery Generator G11 
			Power setting: Level 5</td>
		</tr>
		<tr>
			<td>Ultrasonic SEDs</td>
			<td>Medtronic, Minneapolis, MN</td>
			<td>Sonicision&#160;</td>
			<td>Generator: Sonicision Reusable Generator 
			Power setting: maximum power mode (55 kHz)</td>
		</tr>
	</tbody>
</table>

investigation of the electrophysiological and thermographic safety parameters of surgical energy devices during thyroid and parathyroid surgery in a porcine model

In thyroid and parathyroid surgery, surgical energy devices (SEDs) provide more efficient hemostasis than conventional clamp-and-tie hemostasis in areas with rich blood supply. However, when a SED is activated near the recurrent laryngeal nerve (RLN), the heat generated by the SED may injure the nerve irreversibly. To safely apply SEDs in thyroid/parathyroid surgery, this article introduces experimental porcine model studies to investigate the activation and cooling safety parameters of SEDs in standardized electrophysiological (EP) and thermographic (TG) procedures, respectively. In the EP safety parameter experiments, continuous intraoperative neuromonitoring (C-IONM) is applied to demonstrate the RLN function in real-time. The EP activation study evaluates the safe activation distance of SEDs; the EP cooling study evaluates the safe cooling time of SEDs. In the TG safety parameter experiment, a thermal imaging camera is used to record the temperature change after activating the SED. The TG activation study evaluates the lateral thermal spread distance after SED activation in a dry or humid environment and whether smoke and splashing are generated; the TG cooling study evaluates the cooling time. This will help establish the safety parameters of newly developed SEDs used in thyroid/parathyroid surgery and provide safety guidelines to avoid RLN injury and related complications.

Watch this Scientific Journal Video about Investigation of the Electrophysiological and Thermographic Safety Parameters of Surgical Energy Devices During Thyroid and Parathyroid Surgery in a Porcine M

Investigation of the Electrophysiological and Thermographic Safety Parameters of Surgical Energy Devices During Thyroid and Parathyroid Surgery in a Porcine Model

The safe application of newly developed surgical energy devices in thyroid/parathyroid surgery attracts the attention of surgeons. Animal experimental models can avoid unnecessary trials and errors in human surgery. This report aims to demonstrate electrophysiological and thermographic methods to evaluate the safety parameters of SEDs in thyroid/parathyroid surgery.

In thyroid and parathyroid surgery, surgical energy devices (SEDs) provide more efficient hemostasis than conventional clamp-and-tie hemostasis in areas ...

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