Modern technology protects patients’ nerves during surgery


The latest piece of technological kit is becoming so essential to surgeons they “feel naked without it”.

Associate Professor Mark Sywak, a specialist endocrine surgeon at Sydney’s North Shore Private Hospital, is singing the praises of the NIM Vital neuromonitoring system, designed to help protect patients’ nerves during surgery.

“This new tech represents the next generation of neuromonitoring,” he said.

“With this new machine, there are a number of benefits. Firstly, it’s easy to set up for our nursing staff.

“Secondly, it doesn’t interfere with any other electronic equipment in the room and thirdly, it captures a lot of data, it measures a lot of physiological things, including how strong the nerves are, which is great for research.

“If this piece of equipment is being used elsewhere, or is not available, we really miss it – we feel naked without it.”

The NIM system, designed by Medtronic, was recently used by Dr Sywak on a 32-year-old patient from St Leonards in Sydney.

“This particular patient was a classic example of thyroid surgery, she was young, female and needed surgery on a suspicious nodule,” Dr Sywak said.

“She needed to get back to work as quickly as possible with minimal down time or post-surgery complications.

“It’s likely she will need to come back for a second round of surgery on the other side of her thyroid, and for re-operative surgery, this system is particularly useful.

“Most surgeons will tell you that going in a second time is more difficult, but with this tech it pretty clearly benefits the patient.”

Nerve monitoring is used in a range of surgeries, including ear, nose and throat and general procedures. The NIM system features wireless patient interface, a large touch screen and real-time feedback on nerve function.

Thyroid surgery involves a higher risk of nerve damage, which can result in the patient having difficulty speaking or swallowing.

“Thyroid surgery involves a cut in the neck to remove some or all of the thyroid and there’s a lot of potential there for nerve damage,” Dr Sywak said.

“The vocal chords are right there and any damage there it’s obviously difficult to talk and if there’s a fair bit of damage, it can be difficult to breathe.

“The recurrent laryngeal nerve is a delicate strand about the same as a length of fishing line, it runs along the windpipe, next to the thyroid.

“Former NSW premier Neville Wran had damage to his nerves through thyroid surgery and that resulted in that gravelly, husky voice of his.

“On the face of it, that’s not too bad, but it can be tiring to speak, people have trouble understanding you and if you’re someone who relies on their voice for work – like a teacher, lawyer, or singer – then you could be in real trouble.”

Dr Sywak said Australia had a high rate of thyroid disease, with one in eight people affected.

“There’s lots of areas here where people are iodine deficient, we have a high incidence of goitre and we have a high rate of thyroid cancer as well – we’re not quite clear on the reasons for that, it might be dietary or just an increase in the pick-up of cancer through screening,” he said.

Dr Sywak said while the concept of nerve monitoring was not new, the NIM system was a “significant modification of existing technology".

“It’s useful all round, particularly for the young surgeon, as it allows them to learn and improves the quality of surgery.

“The NIM system, we’ve been using it for the past five or six years, but it’s now (with this new upgrade) become really important,” he said.

“It helps confirm the anatomy and confirms that the nerve is intact and is functioning when you’re finished the surgery.

“Medtronic have realised how important this technology is and they’re refining it, which is great.”

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