NIM
Nerve Monitoring Systems

NIM Nerve Monitoring Systems

Intraoperative NIM nerve monitoring systems enable surgeons to identify, confirm, and monitor motor nerve function to help reduce the risk of nerve damage during various procedures, including ENT and general surgeries.

NIM 3.0 Nerve Monitors

NIM-Response System for ENT Surgery

NIM-Response 3.0 for ENT surgery

NIM-Neuro System for Neurotology Procedures

NIM-Neuro 3.0 for neurotology

Based on more than 20 years of experience, the NIM-Response® 3.0 and NIM-Neuro® 3.0 offer advanced nerve monitoring technology with an easy-to-use interface. NIM® systems monitor EMG activity from multiple muscles. If there is a change in nerve function, the NIM system may provide audible and visual warnings to help reduce the risk of nerve damage.

Our NIM 3.0 systems feature an intuitive touchscreen, three simple user modes, and default or custom settings. They also offer:

  • Monitoring during bipolar cautery
  • Artifact detection software
  • Stim Bur integration for the Visao® Drill
  • Real-time continuous monitoring with the APS® Electrode
  • Control from the surgical field
  • Multiple USB ports for easy documentation 

Choose Your Nerve Monitoring System

NIM-Response 3.0

  • Monitors up to four channels of nerve-muscle combinations at a time
  • Frequently used in ENT surgery, skull-based, and head and neck procedures 

NIM-Neuro 3.0

  • Monitors up to eight channels of nerve-muscle combinations
  • Typically used during complex and delicate surgeries, such as glomus or acoustic tumor removals 
  • Microscope overlay imports the NIM signal through select high-end microscopes as the surgeon operates

Ongoing Service and Support

Upon installation of our NIM Nerve Monitoring System, we provide thorough on-site training for you and your staff, as well as ongoing service and training as needed – including a dedicated NIM HelpLine.

How It Works

NIM System Detecting EMG Event

Detail: NIM System detects an EMG event and allows you to verify nerve function

Our NIM® Nerve Monitoring System is an electromyographic (EMG) monitor for intraoperative use during various surgeries, including ENT and general surgical procedures in which a nerve may be at risk due to unintentional manipulation. NIM nerve monitoring electrodes are placed in the appropriate muscle locations in the patient for the procedure being performed. (Color-coded placement guides are included in the NIM software.)

These electrodes are connected to the NIM Nerve Monitoring System, which continuously monitors EMG activity from muscles innervated by the affected nerve. When a particular nerve has been activated or stimulated, the NIM System warns the surgeon and operating room staff, providing both visual alerts on the color touchscreen monitor and audio feedback to help minimize trauma to the nerve.

Surgeons can use monopolar and bipolar stimulating probes and dissection instruments with the NIM Nerve Monitoring System to assist in early nerve identification and confirmation. These tools may be used to locate, identify, and map the particular nerve and branches, as well as verify nerve function and integrity.

By combining sophisticated hardware electronics and intuitive software, our NIM Nerve Monitoring Systems help surgeons perform critical procedures while preserving nerve function and improving patient safety.

Why Nerve Monitoring Is Needed

Nerve Injury During ENT, Head and Neck, and Other Surgeries

Even with a detailed knowledge of anatomy and surgical skill, motor nerves can sometimes be difficult to identify during surgery due to disease, a previous operation, or normal anatomical variations.

Patients can suffer temporary or permanent damage if a nerve is irritated or injured. For example, during skull-based surgery, the facial nerve is commonly exposed and at risk for injury. Since this nerve controls all movements and expressions of the face, damaging this nerve can have devastating physical and emotional results.

Sometimes minor irritation or stretching of the facial nerve can lead to temporary or permanent symptoms of nerve damage, such as facial weakness, numbness, or twitching. Severing the facial nerve, although rare, causes facial paralysis that resembles the effects of a stroke.

Similarly, the recurrent laryngeal nerve, a branch of the vagus nerve, is one of the nerves at risk during neck dissections, including thyroid surgery. Damaging this nerve can severely affect an individual’s ability to speak, swallow, and aspirate. Clinical evidence demonstrates the benefits of intraoperative nerve monitoring for nerve preservation and as a risk-minimizing tool.1-13

Medtronic’s NIM® Nerve Monitoring Systems help surgeons locate and identify the nerve, monitor and control manipulation effects on the nerve, and confirm nerve integrity prior to completing the surgery. Patients can learn more about thyroid surgery and nerve monitoring in our patient information section.

References

  1. Lo C, Kwok F, Yuen P. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Archives of Surgery 2000;135(2): 204-207.
  2. Dionigi G, et al. The technique of intraoperative neuromonitoring in thyroid surgery. Surg Technol Int. 2010;19: 25-37.
  3. Dionigi G, et al. Why monitor the recurrent laryngeal nerve in thyroid surgery? J Endocrinal Invest. 2010; 33: 819-822.
  4. Randolph GW. Surgery of the Thyroid and Parathyroid Glands. Chapter 25: Surgical Anatomy of the Recurrent Laryngeal Nerve (p316). Elsevier Science (USA), 2003.
  5. Randolph GW and Dralle H with the International Intraoperative Monitoring Study Group. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 2011; 121:S1-S16.
  6. Dralle H. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg. 2008 32(7): 1358-1366. This article received the World Journal of Surgery award for Best Paper in 2008 and identifies risk-minimizing tools to help avoid recurrent laryngeal nerve palsy. 
  7. Thomusch O, Sekulla C, Walls G, Machens A, Dralle H. Intraoperative neuromonitoring of surgery for benign goiter. Amer J Surg. 2002;183(6): 673–678.
  8. Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, Grond S, Mühlig HP, Richter C, Voß J, Thomusch O, Lippert H, Gastinger I, Brauckhoff M , Gimm O. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery. 2004;136:1310–1322.
  9. Eisele DW. Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve. Laryngoscope. 1996;106: 443–449.
  10. Chiang F-Y, Lu I-C, Chen H-C, Chen H-Y, Tsai C-J, Hsiao P-J, Lee K-W, Wu C-W. Anatomical variations of recurrent laryngeal nerve during thyroid surgery; how to identify and handle the variations with intraoperative neuromonitoring. Kaohsiung J Med Sci. 2010; 26(11): 575-583.
  11. Chiang FY, et al. Intraoperative neuromonitoring for early localization and identification of recurrent laryngeal nerve during thyroid surgery. Kaohsiung J Med Sci. 2010; 26(12): 633-638.
  12. Chiang FY, et al. Standardization of intraoperative neuromonitoring of recurrently laryngeal nerve in thyroid operation. World J Surg 2010; 34(2): 223-229.
  13. Dralle H, et al. What benefits does neuromonitoring bring to thyroid surgery? Artz und Krankenhaus. 2004; 369-376.

 

Last updated: 22 Jan 2013

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