Chapter 9 during thyroid surgery15. Intraoperative EMG‐based nerve monitoring (IONM)16, has been introduced to improve the incidence of RLN palsy. However, so far no significant benefit of IONM above visual inspection alone has been found17. Optical spectroscopy techniques have shown potential for differentiation of biological tissues as a basis for a feedback system to enhance nerve preservation in oral and maxillofacial surgery18. Ex vivo18,19 and in vivo20 spectroscopic measurements (350 – 650 nm) have been performed on skin, fat, muscle and nerve tissues during animal experiments. ROC analysis (after leave‐one‐out cross‐validation) showed that almost all tissue types could be differentiated very well (accuracies of up to 100%) by diffuse reflectance spectroscopy, followed by principal component analysis and linear discriminant analysis. However this study was performed on a limited number of animals. From ex vivo and in vivo experiments in a swine model, Nachabé et al.21,22 showed the benefit of extending the ultraviolet and visible wavelength range into the infrared, up to 1600 nm, providing additional information regarding tissue concentrations of the biological chromophores water and lipid. Cao et al. underlined the potential of multispectral imaging in the so‐called extended near‐infrared window based upon these endogenous chromophores23. The present study is a first fibre‐optic wide band (350 – 1830 nm) in vivo human spectrometric exploration, with the ultimate long term goal of obtaining nerve‐specific image enhancement during surgery. We use signal‐intensity independent features derived from spectroscopic data acquired during thyroid and parathyroid surgery. To explore the robustness of the classification, we tested the performance using the spectral data from nerve tissue in a different anatomical region, acquired during carpal tunnel release surgery. Methods In vivo human tissue measurements were performed at the Department of Surgery of Maastricht University Medical Center (MUMC, Maastricht, The Netherlands) during thyroid and parathyroid surgery (surgeon N.D.B.) and at the Department of Neurosurgery of Canisius Wilhelmina Hospital (CWZ, Nijmegen, The Netherlands) during carpal tunnel release procedures (surgeon M.t.L.). Prior to measurements, approvals were granted by the local institutional review boards of Maastricht University Medical Center (registration number METC 10‐4‐035) and Radboud University Nijmegen Medical Center (registration number 2012/446), and preoperative written informed consent was obtained from all patients. 130
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