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Thyroid surgery

  • Situation

    With over 100,000 operations per year performed in Germany alone, thyroid surgery is among the most common surgical procedures. and yet, variations in the anatomy and location of nerves and poor visibility during recurrent tumour operations are the most common reasons for N. recurrens paresis (damage to the vocal cord nerve) - a complication with serious consequences.

    Over the past two decades, neuromonitoring has become invaluable as a way of locating and testing the function of the s N. laryngeus. Most hospitals would not want to be without it.

  • Neuromonitoring

    Neuromonitoring helps surgeons to locate the vulnerable vocal cord nerve and test its function. This is done by exciting the nerve by means of minute electric impulses from specific stimulation probes. When the probe tip touches tissue close to the nerve, it triggers an action potential which is carried to the target muscle by the intact nerve. At the target muscle (M. vocalis = vocal cord muscle), a compound muscle action potential (CMAP) is generated, which is recorded through electromyography and made visible and audible to the surgeon.

  • Continuous Monitoring

    When introducing VANESSA to the market for the first time in January 2009, Dr. Langer Medical GmbH offered a system that permits continuous monitoring of the vocal nerve. This innovative method involves a stimulation electrode that is placed on the N. vagus during the entire operation. The permanent background stimulation enables the surgeon to notice any changes in the signal immediately and react accordingly, e.g. by avoiding strain on the nerve and thus preventing permanent damage.


    Reduced to the essentials – that is the success factor of our new device series with the abbreviation SI. Less important functions in the background, greater visibility of the fundamentals, that was the major objective.

    Nevertheless we integrated new features that facilitate the detection of critical signal changes during continuous monitoring of RLN functions.

    Contact us. We will be pleased to show you what makes our neuromonitors even better. 

  • Saxophone electrode

    Due to its special saxophone-like shape, our new Saxophone electrode is one of the safest and most reliable tools for continuous laryngeus nerve monitoring by means of vagus nerve stimulation.

    It originates from an idea by Professor Dr. med. Wolfram Lamadé: undoubtedly one of the leading pioneers of continuous neuromonitoring during thyroid surgery. The Saxophone electrode perfectly complements our product portfolio in the field of IONM accessories.  

  • Full Disclosure

    During continuous monitoring of the recurrent laryngeal nerve (RLN) the vagus nerve is stimulated with our new Saxophone electrode three times per second. Thus, 180 stimulation responses of the vocal cords are recorded per minute and more than 5000 responses in half an hour. With this large amount of data it is not easy to retrieve the events quickly in retrospect.

    In our full disclosure display you can easily and quickly scroll through the stored data of the surgery minute by minute. The review of events becomes a breeze.

    By touching visible signal changes on the screen the selected muscle action potentials are shown enlarged like through a magnifying glass, with indication of amplitude and latency, and can be documented directly on paper or as a PDF file.

  • One-touch Report

    With our one-touch report function you quickly generate a clear and detailed report at the end of the surgery. We will create a customised report template for you that is suitable for your clinic and according to your requirements.

    The reports can also be saved as PDF files on a USB stick and printed or archived on your computer at any time.

  • Patient-side junction box

    Interfering cables are among the most widespread causes and sources of accidents in the use of medical instruments in the operating room.

    The AVALANCHE® SI systems features a central junction box placed next to the patient. All the cables of stimulation probes and recording electrodes are connected to this box. Only a single cable leads from the operating table to the device!

  • Remote control

    Whether by a tablet computer, a smartphone or a computer running one of the commonly used operating systems, the neuromonitor AVALANCHE® SI can be remotely controlled by all these devices!

    As a result, the information is available for you anytime, anywhere.

  • HIS Interface

    Automated processes decisively simplify everyday life. Due to this, we can integrate our neuromonitors into your infrastructure when required. The patient data can be easily transferred from the database and then the operation report can be saved in the electronic patient record by clicking a button. This not only saves time and money but also helps to protect the environment simultaneously.


  • Trending

    The display of the continuously calculated amplitude, latency and muscle action potential parameters (ALM trend analysis) provides information about critical changes of nerve function within a defined time period.

    The trend graph display can at any time be activated or deactivated as needed.

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