Lab Anim Res.  2012 Dec;28(4):223-228. 10.5625/lar.2012.28.4.223.

Development of a canine model for recurrent laryngeal injury by harmonic scalpel

• Lee KE
• Jee HG
• Kim HY
• Park WS
• Park SH
• Youn YK

• KMID: 1431403
• DOI: http://doi.org/10.5625/lar.2012.28.4.223

Abstract

Various energy devices had been used in thyroid surgery. Aim of study is to develop canine model for recurrent laryngeal nerve injury by harmonic scalpel and to evaluate feasibility of using this model for evaluating the safety use of harmonic scalpel during thyroid surgery. Nine dogs were divided into 3 groups according to distance between harmonic scalpel application and recurrent laryngeal nerve; group 1 (1 mm), 2 (2 mm), and 3 (3 mm). Vocal cord function was assessed pre- and postoperatively using video laryngoscopy. Harmonic scalpel was applied adjacent to left recurrent laryngeal nerve and, two weeks later, right recurrent laryngeal nerve at assigned distances. Recurrent laryngeal nerves were evaluated for subacute and acute morphologic changes. Laryngoscopy demonstrated 3 abnormal vocal cords in group 1, 1 in group 2, and no in group 3 (P=0.020). Subacute histologic changes were observed in nerves with abnormal function. Acute histologic changes were observed 5/8 (62.5%) in group 1, 1/7 (14.3%) in group 2, and not in group 3. We developed canine model for recurrent laryngeal injury. The functional outcomes matched with the histologic changes. These warrant further study to determine the safety margin for energy device in vicinity of recurrent laryngeal nerve.

Keyword

Recurrent laryngeal nerve; canine model; harmonic scalpel; safety margin; nerve damage; ultrasonic shears

MeSH Terms

Animals
Dogs
Laryngoscopy
Recurrent Laryngeal Nerve
Recurrent Laryngeal Nerve Injuries
Thyroid Gland
Vocal Cords

Figure

• 

  Figure 1 Schematic illustration of initial (A) and second (B) operation. (A) After performing a left thyroid lobectomy, the harmonic scalpel (arrow) was applied near the recurrent laryngeal nerve at the assigned distance. (B) Two weeks after the initial operation, the left recurrent laryngeal nerve was harvested (dotted box). After performing a right thyroid lobectomy, the harmonic scalpel was applied to the tissue adjacent to the right recurrent laryngeal nerve at the assigned distance (arrow). All three fragments of right recurrent laryngeal nerve were harvested (dotted box).

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  Figure 2 Functional and morphological results of an animal from group 1 (1 mm). (A) Operative field showing the harmonic scalpel being applied at a distance of 1 mm from the recurrent laryngeal nerve. (B) Postoperative vocal cord examination showing a fixed, paramedian left vocal cord. (C) Nerve stained with Luxol fast blue showing atrophic changes including marked myelin and axonal loss (Scale bar, 10 µm).

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  Figure 3 Functional and morphological results of an animal from group 3 (3 mm). (A) Operative field showing the harmonic scalpel being applied at a distance of 3 mm from the recurrent laryngeal nerve. (B) Postoperative vocal cord examination showing normal mobility of the left vocal cord. (C) Neurofilament stained nerve demonstrating a normal appearance with no axonal loss (Scale bar, 10 µm).

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