Safety of LigaSure in recurrent laryngeal nerve dissection‐porcine model using continuous monitoring

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 f...

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Bibliographic Details
Published in:The Laryngoscope 2017-07, Vol.127 (7), p.1724-1729
Main Authors: Dionigi, Gianlorenzo, Chiang, Feng‐Yu, Kim, Hoon Yub, Randolph, Gregory W., Mangano, Alberto, Chang, Pi‐Ying, Lu, I‐Cheng, Lin, Yi‐Chu, Chen, Hui‐Chun, Wu, Che‐Wei
Format: Article
Language:English
Subjects:
Animals
Cooling
Dissection
Electromyography
Equipment Safety
Hypothermia, Induced
intraoperative neuromonitoring
LigaSure
Monitoring, Intraoperative
Recurrent laryngeal nerve
Recurrent Laryngeal Nerve - physiopathology
Recurrent Laryngeal Nerve - surgery
Recurrent Laryngeal Nerve Injuries - physiopathology
Recurrent Laryngeal Nerve Injuries - prevention & control
Surgical Instruments
Swine
thyroidectomy
Thyroidectomy - instrumentation
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Summary: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
ISSN:0023-852X
1531-4995
DOI:10.1002/lary.26271