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Investigation of the regeneration potential of the recurrent laryngeal nerve (RLN) after compression injury, using neuromonitoring

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Abstract

Introduction

The aim of this study was to investigate the regeneration potential of RLN after the compression of the nerve, without disrupting its continuity, using neuromonitoring.

Methods

In the first operation, the RLN and nervus vagus of adult Goettingen minipigs were dissected free, and the neuromonitoring parameters (amplitude, threshold and lag time of signal) were measured. Injury of the RLN was induced using a “bulldog” clamp. When the signal was no longer detectable, after the 15 min regeneration phase, the operation was finished. The neuromonitoring studies (see above) were repeated in a second operation 6 months later.

Results

(1) After the first operation, acute clamping of the RLN led to a reduction in the amplitude of the neuromonitoring signal; the lag time and the threshold of signal remained. Complete restitution of the signal was observed during the first regeneration phase. Repeated clamping led to complete disappearance of the signal. (2) During the second operation, i.e., after 6 months of regeneration, the neuromonitoring signals of both RLN and nervus vagus were detected in 93% of the GMP. No statistical differences (p = 0.17) were noticed between the amplitude of the RLN before the nerve injury (first operation) and after nerve regeneration (second operation). A significant increase in the lag time (p < 0.0005) was shown for both RLN and nervus vagus.

Conclusions

The acute compression of RLN can only be detected by observing the amplitude of the neuromonitoring signal. Restitutio ad integrum is possible after a short clamping period but it is important to preserve the RLN continuity.

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Acknowledgements

The authors wish to thank A. Reichert, J. Weinberger, P. Heuler, and S. Endres for their assistance by the large animal operations and L. Stevenson-Knebel for her kind support in proofreading this paper.

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Authors and Affiliations

  1. Department of General and Visceral Surgery, Hospital of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, D-55131, Mainz, Germany

    Vasiliy Moskalenko & Stephan Timm

  2. Surgical Clinic I, Leopoldina Hospital, Schweinfurt, Germany

    Markus Hüller

  3. Department of Oncology and Thyroid Surgery, Medical University, Minsk, Belarus

    Yuriy Demidchik

  4. Surgical Clinic I, University Hospital, Wuerzburg, Germany

    Martin Gasser, Arnulf Thiede & Karin Ulrichs

  5. Department of Endocrine Surgery, Marien-Hospital, Kassel, Germany

    Wulf Hamelmann

Authors
  1. Vasiliy Moskalenko
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  2. Markus Hüller
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  3. Martin Gasser
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  4. Yuriy Demidchik
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  5. Arnulf Thiede
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  6. Stephan Timm
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  7. Karin Ulrichs
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  8. Wulf Hamelmann
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Corresponding author

Correspondence to Vasiliy Moskalenko.

Additional information

Vasiliy Moskalenko and Markus Hüller contributed equally to this paper

Best of Endocrine Surgery in Europe 2008

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Moskalenko, V., Hüller, M., Gasser, M. et al. Investigation of the regeneration potential of the recurrent laryngeal nerve (RLN) after compression injury, using neuromonitoring. Langenbecks Arch Surg 394, 469–474 (2009). https://doi.org/10.1007/s00423-008-0407-2

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  • DOI: https://doi.org/10.1007/s00423-008-0407-2

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