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Safety of LigaSure in recurrent laryngeal nerve dissection‐porcine model using continuous monitoring
Author(s) -
Dionigi Gianlorenzo,
Chiang FengYu,
Kim Hoon Yub,
Randolph Gregory W.,
Mangano Alberto,
Chang PiYing,
Lu ICheng,
Lin YiChu,
Chen HuiChun,
Wu CheWei
Publication year - 2017
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26271
Subject(s) - recurrent laryngeal nerve , medicine , dissection (medical) , surgery , thyroid
Objectives/Hypothesis This study investigated recurrent laryngeal nerve (RLN) real‐time electromyography (EMG) data to define optimal safety parameters of the LigaSure Small Jaw (LSJ) instrument during thyroidectomy. Study Design Prospective animal model. Methods Dynamic EMG tracings were recorded from 32 RLNs (16 piglets) during various applications of LSJ around using continuous electrophysiologic monitoring. At varying distances from the RLN, the LSJ was activated (activation study). The LSJ was also applied to the RLN at timed intervals after activation and after a cooling maneuver through placement on the sternocleidomastoid muscle (cooling study). Results In the activation study, there was no adverse EMG event at 2 to 5 mm distance (16 RLNs, 96 tests). In the cooling study, there was no adverse EMG event after 2‐second cooling time (16 RLNs, 96 tests) or after the LSJ cooling maneuver on the surrounding muscle before reaching the RLNs (8 RLNs, 24 tests). Conclusion Based on EMG functional assessment, the safe distance for LSJ activation was 2 mm. Further LSJ–RLN contact was safe if the LSJ was cooled for more than 2 seconds or cooled by touch muscle maneuver. The LSJ should be used with these distance and time parameters in mind to avoid RLN injury. Level of Evidence N/A. Laryngoscope , 127:1724–1729, 2017