A complete connection concept

Inomed IOM-Accessories2

Inomed stimulation and recording accessories have been specifically developed to meet intraoperative applications.

  • Thyroid surgery
  • Pelvic neuromonitoring

Our accessories portfolio includes stimulation probes and electrodes (e.g. subdermal needle electrodes) for stimulation and recording. These are complimented by color-coded adapter boxes and connecting cables in a wide range of lengths.

Delta electrode – continuous monitoring of the recurrent laryngeal nerve during thyroidectomy

Improved information on nerve state using continuous neuromonitoring of the recurrent laryngeal nerve

Thyroid disorders affect millions of people worldwide. In many cases, surgical treatment is necessary and often the only solution. For example, where a goiter, an enlargement of the thyroid gland, has formed, or if malignant changes are found, surgical intervention is recommended.

In the case of surgical intervention where partial removal of the thyroid gland (subtotal thyroidectomy) or its complete removal (total thyroidectomy) is required, these procedures carry a risk of damage to the vocal cord nerve, the recurrent laryngeal nerve. If the recurrent laryngeal nerve is impaired or damaged, this can have serious consequences for the patient. Impairment or damage to the recurrent laryngeal nerve can result in short-term hoarseness after surgery or even lead to permanent bilateral vocal cord paralysis.

Avoiding bilateral vocal cord paralysis

Inoperative neuromonitoring  during thyroid surgery enables the function of the recurrent laryngeal nerve to be monitored throughout. The continuous monitoring process enables the surgeon to make informed decisions during surgery. Following surgery, a definitive statement can be made as to nerve function. The ultimate goal of recurrent laryngeal nerve monitoring is to minimize nerve impairment and to avoid bilateral vocal cord paralysis.

During the procedure, the surgeon is able to use a hand probe to locate the recurrent laryngeal nerve, map it and check its function. Nerve function is therefore recorded both at the beginning and at the end of the operation. In addition, continuous neuromonitoring allows for both audible and visual feedback of the nerve function in real time and enables the surgeon to react quickly to avoid vocal cord paralysis.

In continuous recurrent laryngeal nerve monitoring, the vagus nerve is stimulated so as to monitor and protect the recurrent laryngeal nerve in the surgical area.

The delta-electrode is placed around the vagus nerve and thus always keeps contact with the nerve and delivers stimulation pulses at the defined rate and threshold.

Perfect fit on the nerve

The distinct advantage of the electrode is its delta-like shape and form factor. The shape enables the electrode to be positioned optimally on the nerve and prevents the electrode from slipping or sliding off. As a result of the constant contact with the vagus nerve, technically-induced signal attenuation and even signal loss can be avoided. The surgeon can thus immediately see if the recurrent laryngeal nerve is at risk and can act before a reduction in nerve conductivity becomes an irreversible vocal cord paralysis.

Using inoperative nerve monitoring, and depending on nerve performance during the procedure, the surgeon has the option of ending the procedure after a unilateral thyroidectomy if the results from nerve monitoring are inconclusive or sub-optimal. After successfully maintaining the ipsilateral function of the recurrent laryngeal nerve, the surgeon is able to continue operating contra laterally with a higher degree of confidence. This method helps to identify nerve impairment at an early stage and therefore avoid bilateral vocal cord paralysis.

pIOM accessories – for professional pelvic monitoring

The pIOM technique enables the intraoperative monitoring of autonomic nerves in the small pelvis. The nerve structures can be monitored and nerve impairment avoided, thereby enabling the patient to maintain quality of life. The pIOM accessories developed by inomed for this specific procedure form an important part of the success of surgical interventions in the pelvis.

Methodology for pelvic monitoring

The world’s newest methodology for pelvic monitoring is based on proven neuromonitoring techniques and technologies developed by inomed. The techniques and technologies have been developed following many years of clinical research in the processes of monitoring autonomic nerves in the pelvis. Following exhaustive testing and validation processes, the pIOM technique is now available for pelvic monitoring during intraoperative procedures.

Pelvic intraoperative monitoring helps surgeons to protect the anorectal and urogenital functions, and thus helps to maintain thepatient’s quality of life following surgery. As a result, pelvic monitoring can reduce postoperative follow-up costs and contribute to the delivery of state-of-the-art medicine.

pIOM technical applications currently include pelvic neuromonitoring and are especially useful for  total mesorectal excision. The technology has other applications, for example, in small pelvis interventions nerve impairment may be prevented by the use of pelvic monitoring. Other surgical indications include proctology, gynecology and urology.

pIOM accessories for professional pelvic monitoring

In order to use the pIOM technique for pelvic monitoring during surgery on a colorectal carcinoma, a range of pIOM accessories are required. Monitoring the anorectal function requires that electrodes are placed on the anal sphincter to conduct the EMG muscle response. The function of the bladder is monitored via bladder pressure measurement. Neuromodulation is performed by stimulating the corresponding nerve structures using a bipolar handheld probe. With an intact nerve function, a response signal is recorded from the anal sphincter electrodes and, depending on the nerve structure stimulated, a corresponding pressure measurement is performed and then made available. These responses are presented on screen, with an audio signal output being optional. With pelvic monitoring, the surgeon is able to localize nerve structures and test their function. The results are stored with the patient records and can be documented in accordance with procedure.  

Nerve impairment and physiological dysfunction can be avoided

The monitoring of nerves and nerve structures is an important tool for surgical procedures in the small pelvis. The anorectal and urogenital functions can be monitored with accessories specially designed for pelvic monitoring. In this way, nerve impairment and any resulting dysfunctions can be avoided, while the quality of life for patients can be maintained postoperatively. Standardized implementation of pelvic monitoring can result in an improvement in patient care and a reduction in complication rates.

In addition to their use in relation to signal recording, electrodes, including needle electrodes, can also be used for stimulating nerve and muscle tissue. Application-specific electrodes with a range of different geometries have been optimized for use with a range of multimodality applications (surface and needle electrodes). All electrodes, including needle electrodes, can be used for all measurement modalities (AEP, EEG, EMG, MEP, SEP, VEP) in a multimodal neuromonitoring application. All electrodes also feature a 1.5 mm safety connector and are compatible with a variety of connection schemes on other manufacturer systems.
The subdermal needle electrodes available from inomed provide an easy and reliable patient connection to enable the high-quality recording of electrophysiological signals. These electrodes can also be used for the electrical stimulation of nerve and muscle tissue. Subdermal needle electrodes are also available in the form of corkscrew electrodes, hookwire electrodes, hook electrodes and short needle electrodes for pediatric applications. In addition, the range offers various bipolar needle electrodes, including electrodes for vocalis and oculomotor nerve recording.

The Trigon SDN electrode is a special form factor subdermal needle electrode. As a result of its extremely thin geometry and 30° angle to the needle, the special hand-piece on the Trigon enables an easy to manipulate atraumatic fixation. All needle electrodes are available with different needle and cable lengths, as well as different color combinations.

The inomed D-wave electrode is a bipolar flexible drainage and stimulation electrode. It can be used for recording both D- and I-waves. The D-wave electrode can also be used to stimulate the spinal cord and enables electrical intraoperative functional testing during the procedure. In addition, this flexible electrode is also used in the postoperative prognosis of spinal cord function in neurosurgery, spinal surgery and vascular surgery.
inomed strip and grid electrodes are typically used for reverse-phase SEPs, direct cortical stimulation – bipolar or monopolar against a counter electrode (e.g. needle electrodes). In addition, these electrodes can also be used for epilepsy surgery. The electrodes are available in a range of designs with 4, 6 or 8 contacts per strip. The strips are combined in a range of configurations to deliver grinds of differing numbers of electrodes.
Hand-held stimulation probes are used for electrical stimulation of nerves and neural structures. When used in conjunction with needle electrodes, probes and electrodes can be used to record electrophysiological signals. A wide variety of bayonet-shaped probes are available from our product range. These products help ensure that working under the microscope remains unobstructed and easier for the surgeon. The probes are sterilized with ETO and have a cable with length of 3 m, leading to a standard safety plug for connection to a full range of stimulation outputs and headboxes. All monopolar probe packages include a needle electrode used as a ground electrode. Reusable probes are connected to the systems via a 4-meter probe cable.
Bipolar probes are available in the following form factors; bipolar concentric probes, fork sensors and hook probes. In order to accommodate the various application requirements from direct cortical stimulation to stimulation and recording of direct nerve action potentials (NAPs), bipolar probes can be delivered in a variety of geometries.
Monopolar stimulation probes are primarily used for motor mapping and muscle stimulation in spinal surgery and pedicle screw stimulation. The probes have an active electrode (the probe) and a return electrode (ground), which is placed outside the stimulation region. The electrode used for ground can be in the form of a needle electrode or stick-on pad electrodes.
inomed offers a range of a VEP stimulators that can be used for intraoperative stimulation of the visual pathways. With two independent LED pads, disturbing immobilizing elements are not necessary. The recording of electro-physiological signals takes place on the primary visual cortex and can be carried out using surface electrodes, as well as subdermal needle electrodes.