title: Anatomical basis of the risk of injury to the right laryngeal recurrent nerve during thoracic surgery.
abstract: OBJECTIVE
  Despite the intrathoracic part being short, the right laryngeal recurrent nerve is often injured during thoracic surgery. The aim of this cadaver study was to understand the mechanisms of right laryngeal recurrent nerve injuries during thoracic surgery and to describe anatomical landmarks for its preservation.
  
  
  METHODS
  Dissections were performed on 10 fresh human cadavers. A right anterolateral thoracic wall segment was removed, preserving the first rib. Dissections were carried out to identify the following structures: first rib, esophagus, trachea, right main bronchus, right brachiocephalic and subclavian vessels, azygos vein, phrenic nerve, vagus nerve, and right laryngeal recurrent nerve.
  
  
  RESULTS
  The distance between the origin of the right laryngeal recurrent nerve and its adjacent structures was assessed. Moderate traction of the thoracic part of the vagus nerve resulted in a downward translation of the right laryngeal recurrent nerve's origin. In such conditions, the right laryngeal recurrent nerve's origin was distant of 14.8 mm (±2.89 mm) from the subclavian artery.
  
  
  CONCLUSIONS
  Intraoperative incidence of right laryngeal recurrent nerve direct injury could be decreased by understanding the detailed course of its intrathoracic part. Moreover, traction on the intrathoracic part of the right vagus nerve may result in indirect lesions of the right laryngeal recurrent nerve: stretch induced lesions and nerve vasculature's lesions.
authors.affiliation: Laboratory of Human Anatomy, Purpan Medical University, Université Paul Sabatier, 133 route de Narbonne, 31062, Toulouse, France. vincent_benouaich@yahoo.fr
authors.forename: Vincent
authors.initials: V
authors.lastname: Benouaich
authors.forename: Jean
authors.initials: J
authors.lastname: Porterie
authors.forename: Ourdia
authors.initials: O
authors.lastname: Bouali
authors.forename: Jacques
authors.initials: J
authors.lastname: Moscovici
authors.forename: Raphaël
authors.initials: R
authors.lastname: Lopez
mesh_terms: D001837:Body Weights and Measures / Q000379:methods*; D002102:Cadaver; D004210:Dissection; D005260:Female; D006801:Humans; D008297:Male; D012009:Recurrent Laryngeal Nerve / Q000033:anatomy & histology*; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control*; D012306:Risk; D013903:Thoracic Surgery