Healthcare Professionals
NIM
Nerve Monitoring Systems
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Healthcare Professionals
Nerve Monitoring Systems
Our nerve monitoring products and accessories can be used in conjunction with NIM® Nerve Monitoring Systems during a variety of surgical procedures. These include ENT surgeries, such as otologic procedures and thyroidectomies, as well as other operations performed by endocrine, general, and peripheral surgeons.
Even experienced surgeons find it difficult to visually identify the recurrent laryngeal nerve (RLN) or vagus nerve during thyroid surgery and other neck dissections. Studies show that the rate of RLN injury is under-estimated1-6 and intraoperative nerve monitoring of the RLN is recommended as a risk-minimizing tool.1-4,7-15
NIM® EMG Tubes provide an open airway for patient ventilation and intraoperative nerve monitoring of both vocal cords. If nerve function changes, the NIM System alerts you with visual and audible warnings to help reduce the risk of patient injury.
The NIM TriVantage® EMG Tube is a standard size, non-reinforced, DEHP-free PVC tube that features smooth, conductive silver ink electrodes and a cross-band to guide placement. It has reduced sensitivity to rotation and movement while offering increased EMG responses that facilitate improved nerve dissection.
Together with the NIM System, a properly positioned NIM EMG Tube can reduce the risk of injury to your patient by helping you to:
Only NIM EMG Tubes are tested and validated for use with NIM nerve monitors.
Lo C, Kwok F, Yuen P. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Archives of Surgery 2000;135(2): 204-207.
Dionigi G, et al. The technique of intraoperative neuromonitoring in thyroid surgery.Surg Technol Int. 2010;19: 25-37.
Dionigi G, et al. Why monitor the recurrent laryngeal nerve in thyroid surgery? J Endocrinal Invest. 2010; 33: 819-822.
Randolph GW. Surgery of the Thyroid and Parathyroid Glands. Chapter 25: Surgical Anatomy of the Recurrent Laryngeal Nerve (p316). Elsevier Science (USA), 2003.
Bergenfelz A, Jansson S, Kristoffersson A. Complications of thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients.Langenbecks Arch Surg. 2008; 393: 667-673.
Ready AR, Barnes AD. Complications of thyroidectomy. Br J Surg. 1994; 81: 1555-1556.
Randolph GW and Dralle H with the International Intraoperative Monitoring Study Group. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 2011; 121:S1-S16.
Dralle H. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery.World J Surg. 2008 32(7): 1358-1366. This article received the World Journal of Surgery award for Best Paper in 2008 and identifies risk-minimizing tools to help avoid recurrent laryngeal nerve palsy.
Thomusch O, Sekulla C, Walls G, Machens A, Dralle H. Intraoperative neuromonitoring of surgery for benign goiter. Amer J Surg. 2002;183(6): 673–678.
Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, Grond S, Mühlig HP, Richter C, Voß J, Thomusch O, Lippert H, Gastinger I, Brauckhoff M , Gimm O. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery. 2004;136:1310–1322.
Eisele DW. Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve. Laryngoscope. 1996;106: 443–449.
Chiang F-Y, Lu I-C, Chen H-C, Chen H-Y, Tsai C-J, Hsiao P-J, Lee K-W, Wu C-W. Anatomical variations of recurrent laryngeal nerve during thyroid surgery; how to identify and handle the variations with intraoperative neuromonitoring. Kaohsiung J Med Sci. 2010; 26(11): 575-583.
Chiang FY, et al. Intraoperative neuromonitoring for early localization and identification of recurrent laryngeal nerve during thyroid surgery. Kaohsiung J Med Sci. 2010; 26(12): 633-638.
Chiang FY, et al. Standardization of intraoperative neuromonitoring of recurrently laryngeal nerve in thyroid operation. World J Surg 2010; 34(2): 223-229.
Dralle H, et al. What benefits does neuromonitoring bring to thyroid surgery? Artz und Krankenhaus. 2004; 369-376.
View a short video of how this APS® Electrode works.
Injury to the recurrent laryngeal nerve (RLN) is one of the most serious complications of thyroid surgery. Yet research shows the rate of RLN damage is underestimated.1-5
In between stimulations, nerves can be at risk due to surgical incision, "blind" trauma caused by stretching or manipulation during tumor/thyroid removal, and cumulative trauma or damage that may result in neuropraxia.
Used with the NIM® 3.0, the APS (Automatic Periodic Stimulation) Electrode enables early detection and warning of a change in nerve function. This allows the surgeon to take immediate corrective action to prevent potential injury.6,7 The APS Electrode is placed on the vagus nerve and delivers continuous low-level stimulation. A baseline of nerve function is obtained and subsequent EMG responses are monitored and charted in real time to provide feedback.
Lo C, Kwok F, Yuen P. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Archives of Surgery 2000;135(2): 204-207.
Dionigi G, et al. The technique of intraoperative neuromonitoring in thyroid surgery.Surg Technol Int. 2010;19: 25-37.
Randolph GW. Surgery of the Thyroid and Parathyroid Glands. Chapter 25: Surgical Anatomy of the Recurrent Laryngeal Nerve (p316). Elsevier Science (USA), 2003.
Bergenfelz A, Jansson S, Kristoffersson A. Complications of thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients.Langenbecks Arch Surg. 2008; 393: 667-673.
Ready AR, Barnes AD. Complications of thyroidectomy. Br J Surg. 1994; 81: 1555-1556.
Schneider R, Randolph GW, Sekulla C, et al. Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Head and Neck 2012; doi :10.1002/hed.23187.
Van Slycke S, Gillardin J-P, Brusselaers N, Vermeersch H. Initial experience with S-shaped electrode for continuous vagal nerve stimulation in thyroid surgery.Langenbecks Arch Surg. doi: 10.1007/s00423-013-1068-3. Epub 2013 Mar 5.
We offer a complete line of instruments and accessories for our NIM® Nerve Monitoring Systems. They include:
With more than 20 years of nerve monitoring experience, our instruments and accessories help make nerve monitoring easier and more accurate.
See our complete line of intraoperative nerve monitoring accessories in our ENT Product Catalog.
* For use with NIM-Response 3.0 and NIM-Neuro 3.0 models only.
** Nerve monitoring capability provided by NIM-Response or NIM-Neuro Nerve Monitoring Systems, models 2.0 and later. Must be used with Visao High-Speed Otologic Drill and IPC System.
The innovative Stim Bur Guard for the Visao® High-Speed Otologic Drill is the first and only commercially available surgical tool that combines an electric drill with stimulation for nerve monitoring. It works with our NIM® Nerve Monitoring System to alert you of the bur’s proximity to the facial nerve and help reduce the risk of patient injury during otologic procedures.*
The Stim Bur Guard provides stimulating current to our otologic burs in both static and dynamic modes. Stimulating the nerve while the bur is in use can offer approximately 1-3 mm of advance warning of facial nerve proximity. If nerve function changes, the NIM system provides visual and audible warnings to alert you.
You can use the Stim Bur Guard with or without irrigation, and numerous bur types are available. See the ENT Product Catalog for a complete selection of our otologic burs.
*Nerve monitoring capability provided by NIM-Response® or NIM-Neuro® Nerve Monitoring Systems, models 2.0 and later. Must be used with Visao® High-Speed Otologic Drill and Integrated Power Console (IPC®) System.