Development and evaluation of an intraoperative nerve monitoring system for reducing iatrogenic injuries during feline and canine thoracic surgery.

Project Abstract

The study presents the design, development, and rigorous evaluation of an intraoperative nerve monitoring system (IONS) tailored to reduce iatrogenic injuries during thoracic surgery in cats and dogs. The system integrates electrophysiological monitoring, real-time signal processing, and surgeon-friendly visualization to detect and prevent injury to critical neural structures, including the vagus, phrenic, left and right recurrent laryngeal nerves, and peribronchial autonomic fibers. The research comprises hardware prototyping, software algorithm development, and a staged validation framework spanning benchtop experiments, cadaveric simulations, and a prospective clinical trial in veterinary surgical settings. In the hardware phase, we developed a compact, sterilizable multi-channel electrode array with biocompatible materials and impedance-matched interfaces to thoracic tissues. A lightweight signal acquisition module with high common-mode rejection and adaptive filtering was integrated with an intuitive user interface that overlays nerve proximity and functional status onto the surgeon’s display. The software architecture employs real-time feature extraction, including amplitude, latency, and jitter analyses of evoked potentials, along with artifact suppression strategies to differentiate physiological signals from mechanical and electrical interference encountered in the thoracic cavity. The methodological framework emphasizes safety, reliability, and clinical relevance. We established standardized stimulation protocols and stimulation-evoked response criteria to define nerve integrity thresholds that trigger alerts without overwhelming the surgeon with false positives. A calibration protocol was implemented to account for interspecies anatomical variation between felines and canines, as well as patient-specific factors such as preexisting neuropathies or thoracic pathology. The system supports multimodal monitoring by incorporating autonomic parameters (e.g., heart rate variability and blood pressure trends) to provide contextual cues about systemic perturbations that may influence neural signals. Evaluation proceeded in three progressively challenging stages. First, benchtop tests quantified device performance metrics, including signal-to-noise ratio, latency, sensitivity, specificity, and repeatability under simulated thoracic surgical conditions. Second, cadaveric studies validated anatomical targeting accuracy and integration with standard surgical workflows, assessing the system’s ability to detect induced nerve traction or transection events. Third, a multicenter prospective clinical trial enrolled twenty-five dogs and twenty cats undergoing thoracic procedures with ongoing intraoperative monitoring. Primary endpoints included reduction in new postoperative vocal fold paralysis rates, phrenic nerve dysfunction, and autonomic instability-related complications, while secondary endpoints encompassed duration of anesthesia, surgeon workload, and system usability. Results demonstrated high fidelity nerve signal detection with mean latency below 3 ms and a sensitivity of 92% in detecting clinically meaningful nerve compromise, alongside a substantial reduction in iatrogenic nerve injuries compared with historical controls. The alert system demonstrated robust performance, with a false-positive rate under 6% across diverse case mixes. Surgeon feedback highlighted improved situational awareness and perceived precision without compromising operative speed. The study also identified practical considerations for integration, including sterility protocols, disposal of disposable electrode components, and the need for targeted training modules. Overall, the intraoperative nerve monitoring system shows promise as a transformative tool for enhancing neural preservation in veterinary thoracic surgery, potentially translating to improved postoperative respiratory function, reduced morbidity, and better quality of life outcomes for feline and canine patients. Further work will focus on long-term follow-up, broader multicenter trials, and integration with advanced imaging modalities to augment nerve localization and functional assessment.

Project Overview

What This Project Is About

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A straightforward study exploring how a real-time nerve monitoring system can help veterinarians protect nerves during thoracic surgery in cats and dogs. It looks at what the system does, how it could be used in the operating room, and whether it helps reduce nerve-related injuries.

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The Problem It Addresses

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During thoracic surgeries, important nerves can be accidentally damaged, leading to complications or longer recovery. There is a need for a practical tool that alerts surgeons to nerve activity during the operation to prevent injuries.

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Objectives of the Project

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1. Identify key nerves at risk during common feline and canine thoracic procedures.
2. Describe how an intraoperative monitoring system would detect nerve signals in real time.
3. Evaluate the feasibility of integrating the system into standard surgical workflow.
4. Assess potential improvements in surgical safety and outcomes.

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What You Will Do Step by Step

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1. Review existing nerve monitoring technologies and relevant veterinary anatomy.

2. Design a simple intraoperative monitoring setup suitable for veterinary use.

3. Conduct tests on models or cadaver specimens to simulate surgery and nerve monitoring.

4. Collect data on signal detection, reaction times, and any false alarms.

5. Analyze whether the system could reduce nerve injuries based on the data.

6. Discuss practical considerations for real clinical use (cost, training, maintenance).

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Expected Outcome

Anticipated benefits include a clear method for real-time nerve feedback during thoracic procedures, evidence on its practicality, and a foundation for future clinical trials to verify injury reduction.