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Updated: Jun 27, 2026
Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
Published on: October 24, 2025
Anatomical bases of left recurrent nerve lesions during mediastinoscopy
Vincent Benouaich1, Bertrand Marcheix, Luana Carfagna
1Toulouse-Purpan Medical University, Université Paul Sabatier, Toulouse, France. vincent_benouaich@yahoo.fr
Purpose:
The mechanism of left recurrent laryngeal nerve palsy after cervical mediastinoscopy remains unclear. Our aim is to describe the anatomical bases of this complication.
Methods:
Video-assisted mediastinoscopy was performed on ten fresh human cadavers with simultaneous dissection of the left recurrent nerve.
Results:
Three dissection areas could be described regarding the risk of left recurrent nerve damage: a low risk area, along the right wall and before the upper part of the anterior wall of the trachea; an area at high risk of indirect stretch-induced lesions, between the lower part of the anterior wall of the trachea and the aorta; -an area at high risk of direct injury, against the lower part of the left wall of the trachea.
Conclusions:
Dissection between the trachea and the aorta causes traction on the left recurrent nerve. Indirect stretch-induced injury is probably a frequent mechanism of left recurrent nerve palsy during mediastinoscopy.
