Objective:

To evaluate a novel intraoperative neuromonitoring (IONM)-guided selective vagus-recurrent laryngeal nerve anastomosis (SVRA) technique and compare its immediate electrophysiologic performance with direct anastomosis (DA) in a porcine thyroid surgery model.

Approach:

Key Findings:

• VN motor fibers innervating the laryngeal muscles were predominantly localized to the lateral VN and mostly concentrated in a single strand.
• Both SVRA and DA techniques yielded early EMG recovery, with post-anastomotic amplitudes often exceeding 50% of baseline.
• A cross-innervation model produced immediate EMG responses approaching baseline and bilateral vocal fold activation.
• VN dissection did not cause clinically relevant changes in blood pressure or oxygen saturation.

Interpretation:

IONM-guided SVRA enables selective recruitment of VN motor fibers for targeted RLN reconstruction while largely preserving VN trunk integrity.

Limitations:

• Long-term functional reinnervation remains to be established.

Conclusion:

SVRA is a physiologically grounded and technically feasible reconstructive option that can achieve acute electrophysiological recovery when tension precludes DA during thyroid surgery-related RLN transection.

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