ApplicationsProceduresGeneral surgeryThyroid surgery

ALM technology in thyroid surgery

The cutting-edge ALM (Advanced Laryngeal Monitoring) technology provides reliable signal recording through the interaction of an electrode tube and intelligent software. The 360° electrode surface on the endotracheal tube leads via 8 contacts to 4 channels, from which the Channel Select Software always displays the best signal on the C2 Xplore. This means that the signal remains consistent despite any tube rotation or displacement that may occur. With the ALM technology in combination with the C2 Xplore, you are always ‘One step ahead’.

Brochure – C2 Xplore – Thyroid surgery

Introduction to the ALM technology in thyroid surgery

Treatment process

Preparation

Setup of the system

Neuromonitoring system

The C2 Xplore is placed on an inomed trolley and switched on. While the system is starting up, the Head Box is connected. If required, a mute sensor can also be connected. This is used to suppress HF artefacts and is clamped to the connection cables of the HF accessories. The Head Box of the C2 Xplore can be placed anywhere on the trolley or at the operating table.

Recording

After intubation, the patients are positioned on their back on the operating table with their neck slightly reclined. Due to the 360° coverage of the surface electrodes in the area of the vocal cords, the tube provides a permanently stable signal, even if there is a possibility of slippage. Afterwards, a ground electrode is attached to the patient's clean forehead for recording. Alternatively, a simple needle electrode can be placed in the shoulder. The tube and the ground electrode are connected to a corresponding connection cable. This establishes the connection to the Head Box.

Illustration: laryngeal tube electrode connection

Stimulation

The previously selected stimulation probe is removed from the sterile packaging and placed in the sterile field. The connection cable has so-called ‘touchproof connectors’. These are connected to stimulator 1 on the Head Box of the C2 Xplore at the respective colour-coded sockets. With a monopolar probe, a reference electrode is placed near the wound margin. For continuous neuromonitoring (cIONM) in thyroid surgery, the DELTA-Electrode can optionally be placed on the vagus nerve and connected to stimulator 2 of the Head Box.

Intraoperative neuromonitoring

The stimulation sequence during thyroid surgery always begins with the initial stimulation of the vagus nerve before resection in order to obtain a reference value for the signal quality. Once a sufficient signal is present, the procedure can be continued and the recurrent laryngeal nerve can be stimulated before resection. The initial response signal of the nerves is crucial for the further signal interpretation and the course of the surgery itself. After the thyroidectomy, the function of the recurrent laryngeal nerve is tested again. To exclude the possibility of ongoing damage to the entire nerve pathway of the recurrent laryngeal nerve, the signal quality of the vagus nerve is tested in the final step by stimulating it for the respective surgical side. In a total thyroidectomy, this procedure is also applied to the other side. A comment can be added to the documentation for each response curve. In the subsequent surgical report, all the curves marked with a comment are automatically displayed.

Illustration: anatomy of the thyroid gland periphery

inoView V2

With the inoView V2 app, it is possible to wirelessly mirror the C2 Xplore screen onto a tablet. This provides access to selected functions. The tablet can be equipped with a sterile cover. This enables surgeons to operate the tablet in the sterile field and, for example, to carry out documentation independently during the surgery.

Documentation

Product information

ALM Tube I.D. 7.0, O.D. 9.7

530845

ALM Tube I.D. 7.0, O.D. 9.7

For EMG recording, 4 channels, clear PVC tube, Murphy type, latex free, disposable product, EO sterilised

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ALM Tube I.D. 7.5, O.D. 10.3

530846

ALM Tube I.D. 7.5, O.D. 10.3

For EMG recording, 4 channels, clear PVC tube, Murphy type, latex free, disposable product, EO sterilised

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ALM Tube I.D. 8.0, O.D. 11.0

530847

ALM Tube I.D. 8.0, O.D. 11.0

For EMG recording, 4 channels, clear PVC tube, Murphy type, latex free, disposable product, EO sterilised

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Laryngeal Electrode Select for tube with 6-7 mm inner diameter

530855

Laryngeal Electrode Select for tube with 6-7 mm inner diameter

Adhesive surface=32x29.7 mm, electrode surface=685 mm², with neutral adhesive electrode, disposable product, EO sterilised

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Laryngeal Electrode Select for tube with 7-9 mm inner diameter

530856

Laryngeal Electrode Select for tube with 7-9 mm inner diameter

Adhesive surface=37x37.6 mm, electrode surface=1057 mm², with neutral adhesive electrode, disposable product, EO sterilised

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BCS probe 45 mm angled 30°

522603

BCS probe 45 mm angled 30°

1.5 mm touchproof connector DIN 42802, angled 30°, bipolar concentric, working length=45 mm, total length with handle=155 mm, cable length=3000 mm, disposable product, EO sterilised

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Stimulation probe 45 mm monopolar, angled 30°

525603

Stimulation probe 45 mm monopolar, angled 30°

1.5 mm touchproof connector DIN 42802, angled 30°, active tip=2 mm, working length=45 mm, total length with handle=160 mm, with neutral SDN electrode black, cable length=3000 mm, disposable product, EO sterilised

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Application package Thyroid and ENT with Channel Select for C2 Xplore

508541

Application package Thyroid and ENT with Channel Select for C2 Xplore

Consisting of software licence “Thyroid and ENT”, Head Box and license for 4-channel recording.

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C2 Xplore

508288

C2 Xplore

For intraoperative neuromonitoring. Easy-to-use 8-channel EMG monitor with 2 integrated stimulators, up to 6 application fields and digital integration in the operating theatre, maximum interconnection online and offline. Mains lead and foot switch included. Can be used in combination with an application package.

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inoView V2 Software Module for C2 Xplore

508517

inoView V2 Software Module for C2 Xplore

Software module for the wireless connection to a tablet to use the inoView app for the C2 Xplore. Contains one Wi-Fi stick.

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C2 Xplore Wi-Fi Set for use inside the operating room

508566

C2 Xplore Wi-Fi Set for use inside the operating room

Wi-Fi module for wireless connection to the hospital network and for patient data storage via Wi-Fi for the C2 Xplore. Contains one Wi-Fi stick. Maximum data rate 150 Mbps, supports IEEE 802.11 n, b, g

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HL7 network integration for C2 Xplore

508524

HL7 network integration for C2 Xplore

The network connection via HL7 enables data exchange between C2 Xplore and the hospital network (HIS). Includes license and project costs for the initial setup via remote support. The network connection is complemented by the annual support.

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Further information

Brochure – C2 Xplore – Thyroid surgery

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ApplicationsProceduresGeneral surgeryThyroid surgery

ALM technology in thyroid surgery

Introduction to the ALM technology in thyroid surgery

Treatment process

Preparation

Preparing the tube

Setup of the system

Neuromonitoring system

Recording

Stimulation

Intraoperative neuromonitoring

inoView V2

Documentation

Product information

Further procedures of general surgery

Further information

Search

Watch list

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ApplicationsProceduresGeneral surgeryThyroid surgery

ALM technology in thyroid surgery

Introduction to the ALM technology in thyroid surgery

Treatment process

Preparation

Preparing the tube

Setup of the system

Neuromonitoring system

Recording

Stimulation

Intraoperative neuromonitoring

inoView V2

Documentation

Product information

Further procedures of general surgery

Further information