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

Gianlorenzo Dionigi, Feng Yu Chiang, Hoon Yub Kim, Gregory W. Randolph, Alberto Mangano, Pi Ying Chang, I. Cheng Lu, Yi Chu Lin, Hui Chun Chen, Che Wei Wu

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1724-1729
Number of pages6
Issue number7
Publication statusPublished - 2017 Jul
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2016 The American Laryngological, Rhinological and Otological Society, Inc.


  • LigaSure
  • Recurrent laryngeal nerve
  • electromyography
  • intraoperative neuromonitoring
  • thyroidectomy

ASJC Scopus subject areas

  • Otorhinolaryngology


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