title: Safety of LigaSure in recurrent laryngeal nerve dissection-porcine model using continuous monitoring.
abstract: 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.
  
  
  
  Prospective animal model.
  
  
  
  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).
  
  
  
  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).
  
  
  
  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.
  
  
  
  N/A. Laryngoscope, 127:1724-1729, 2017.
authors: 1st Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy.
authors: Gianlorenzo
authors: G
authors: Dionigi
authors: Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Feng-Yu
authors: FY
authors: Chiang
authors: Department of Surgery, KUMC Thyroid Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors: Hoon Yub
authors: HY
authors: Kim
authors: Division of Thyroid and Parathyroid Endocrine Surgery, Department of Laryngology and Otology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, U.S.A.
authors: Gregory W
authors: GW
authors: Randolph
authors: 1st Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy.
authors: Alberto
authors: A
authors: Mangano
authors: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors: Pi-Ying
authors: PY
authors: Chang
authors: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors: I-Cheng
authors: IC
authors: Lu
authors: Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Yi-Chu
authors: YC
authors: Lin
authors: Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors: Hui-Chun
authors: HC
authors: Chen
authors: Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Che-Wei
authors: 0000-0003-1052-5348
authors: CW
authors: Wu
mesh_terms: D000818:Animals; D004210:Dissection; D004576:Electromyography; D004869:Equipment Safety; D007036:Hypothermia, Induced; D016343:Monitoring, Intraoperative; D012009:Recurrent Laryngeal Nerve / Q000503:physiopathology / Q000601:surgery*; D061226:Recurrent Laryngeal Nerve Injuries / Q000503:physiopathology / Q000517:prevention & control; D013525:Surgical Instruments; D013552:Swine; D013965:Thyroidectomy / Q000295:instrumentation*
keywords: LigaSure; Recurrent laryngeal nerve; electromyography; intraoperative neuromonitoring; thyroidectomy