Abstract Details

Title Use of Intraoperative Neurophysiologic Monitoring (IONM) to Detect Successful Cryoablation in a Robotic-Assisted Thoracic Surgery (RATS) - A Case Report

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P8 - Poster Session 8 (8:00 AM-9:00 AM)

Poster/Presentation
Number 11-024

Objective N/A

Background Persistent postoperative pain following thoracic surgery is often attributable to intercostal nerve injury sustained during the procedure. Advancements in minimally invasive surgical techniques such as Video-Assisted Thoracoscopic Surgery (VATS) and Robotic-Assisted Thoracic Surgery (RATS) have resulted in reduced pain post-surgery, however it remains a substantial clinical concern. The analgesic technique of intraoperative intercostal nerve cryoablation, an opioid-sparing approach, has shown promising results in combatting this problem. However, the current practice, characterized by reliance on anatomical landmarks for probe placement and a predetermined ablation duration, may contribute to inadequate cryoablation owing to potential errors in probe location or insufficient ablation time. This case report emphasizes the innovative use of transcranial motor evoked potentials (tcMEPs) with recording at intercostal muscles to ascertain the successful completion of intercostal nerve cryoablation, signaling potential advancements in the postoperative pain management landscape and a new use case for intraoperative neurophysiologic monitoring (IONM) in thoracic surgeries.

Design/Methods N/A

Results N/A

Conclusions This case report presents a new use of transcranial motor evoked potentials (tcMEPs) to monitor the effectiveness of intraoperative intercostal nerve cryoablation in thoracic surgery. Utilizing intraoperative neurophysiologic monitoring (IONM) in this context represents a novel application in thoracic surgeries. This approach could potentially enhance postoperative pain management, which underscores its clinical impact and signifies a promising path for future investigations.

Authors/Disclosures
Mark Keroles, MD PRESENTER	Dr. Keroles has received intellectual property interests from a discovery or technology relating to health care.
Nicholas Meyers, MD (Stanford)	Dr. Meyers has nothing to disclose.
Ayush Patel	Mr. Patel has nothing to disclose.
Ankita Tippur, MD (UCLA Medical Center)	Dr. Tippur has nothing to disclose.
Felix Chang, MD (Beth Israel Deaconess Medical Center)	Dr. Chang has nothing to disclose.
Leslie H. Lee, MD, FAAN	Dr. Lee has nothing to disclose.
Rohit Gummi, MD (Stanford Medicine)	Dr. Gummi has nothing to disclose.
Scheherazade Le, MD (Stanford University)	Dr. Le has nothing to disclose.
Sungho K. Cho, MD	Dr. Cho has nothing to disclose.
Jaime R. Lopez, MD (Stanford University School of Medicine)	An immediate family member of Dr. Lopez has received personal compensation for serving as an employee of AbbVie. Dr. Lopez has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neurophysiology. Dr. Lopez has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for medical-legal consulting.

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