A Strategy for Using Intraoperative Nerve Monitoring During Esophagectomy to Prevent Recurrent Laryngeal Nerve Palsy

Yuda, Masami; Nishikawa, Katsunori; Takahashi, Keita; Kurogochi, Takanori; Tanaka, Yujiro; Matsumoto, Akira; Tanishima, Yuichiro; Mitsumori, Norio; Yanaga, Katsuhiko

doi:10.21873/anticanres.12385

Cited by 11 publications

(9 citation statements)

References 23 publications

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“…After preliminary screening, 31 studies were retrieved to assess eligibility. Of these, 12 studies which did not compare IONM with non-IONM (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Three case reports on IONM (35)(36)(37), one letter to the editor (38), and two reviews (39,40) were excluded.…”

Section: Search Resultsmentioning

confidence: 99%

Efficacy of Intraoperative Recurrent Laryngeal Nerve Monitoring During Thoracoscopic Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-Analysis

Wang

Guo

et al. 2021

Front. Surg.

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Background: Recurrent laryngeal nerve paralysis (RLNP), a severe complication of mini-invasive esophagectomy, usually occurs during lymphadenectomy adjacent to recurrent laryngeal nerve. This systematic review and meta-analysis aimed to evaluate the efficacy of intraoperative nerve monitoring (IONM) in reducing RLNP incidence during mini-invasive esophagectomy.Methods: Systematic literature search of PubMed, EMBASE, EBSCO, Web of Knowledge, and Cochrane Library until June 4, 2021 was performed using the terms “(nerve monitoring) OR neuromonitoring OR neural monitoring OR recurrent laryngeal nerve AND (esophagectomy OR esophageal).” Primary outcome was postoperative RLNP incidence. Secondary outcomes were sensitivity, specificity, and positive and negative predictive values for IONM; complications after esophagectomy; number of dissected lymph nodes; operation time; and length of hospital stay.Results: Among 2,330 studies, five studies comprising 509 patients were eligible for final analysis. The RLNP incidence was significantly lower (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.12–0.88, p < 0.05), the number of dissected mediastinal lymph nodes was significantly higher (mean difference 4.30, 95%CI 2.75–5.85, p < 0.001), and the rate of hoarseness was significantly lower (OR 0.14, 95%CI 0.03–0.63, p = 0.01) in the IONM group than in the non-IONM group. The rates of aspiration (OR 0.31, 95%CI 0.06–1.64, p = 0.17), pneumonia (OR 1.08, 95%CI 0.70–1.67, p = 0.71), and operation time (mean difference 7.68, 95%CI −23.60–38.95, p = 0.63) were not significantly different between the two groups. The mean sensitivity, specificity, and positive and negative predictive values for IONM were 53.2% (0–66.7%), 93.7% (54.8–100%), 71.4% (0–100%), and 87.1% (68.0–96.6%), respectively.Conclusion: IONM was a feasible and effective approach to minimize RLNP, improve lymphadenectomy, and reduce hoarseness after thoracoscopic esophagectomy for esophageal cancer, although IONM did not provide significant benefit in reducing aspiration, pneumonia, operation time, and length of hospital stay.

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Section: Search Resultsmentioning

confidence: 99%

Efficacy of Intraoperative Recurrent Laryngeal Nerve Monitoring During Thoracoscopic Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-Analysis

Wang

Guo

et al. 2021

Front. Surg.

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“…Fiberoptic laryngoscopy was employed to assess vocal cord mobility in patients complaining of dyspnea or hoarseness, and cord paralysis was defined as a RLN injury. 13 , 20 , 21 Permanent RLN paralysis was considered when there was no evidence of recovery within 12 months. Flap seroma or hematoma was documented in terms of neck swelling and tenderness.…”

Section: Methodsmentioning

confidence: 99%

Learning curve of trans‐areola single‐site endoscopic thyroidectomy in a high‐volume center: A CUSUM‐based assessment

et al. 2023

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BackgroundLimited attempts have been made in trans‐areola single‐site endoscopic thyroidectomy (TASSET) due to technical challenges and the lengthy time for proficiency. This study aimed to define the learning curve of TASSET and to describe improvements in operative performance over time.MethodsBased on 222 consecutive TASSET procedures, the learning curve was established according to the operation time by using cumulative sum analysis (CUSUM). The end‐point of learning curve was defined as the number of cases necessitated to reach the initial surgical proficiency stage. The demographic information, surgical and oncological outcomes, surgical stress, and postoperative complications were also analyzed.ResultsThere were 70 cases of simple lobectomy for benign nodules and 152 cases of lobectomy with central neck dissection (CND) for malignancy. The mean operative time was 106.54 ± 38.07 min (range: 46–274 min). The learning curve identified two phases: the skill acquisition phase (Case 1–Case 41) and the proficiency phase (Case 42–Case 222). There were no significant differences in demographic information, drainage amount and duration, oncological outcomes, and postoperative complications between the two phases (p > 0.05). Both operation time and postoperative hospitalization decreased significantly in Phase 2 (154.63 ± 52.21 vs. 95.64 ± 22.96 min, p < 0.001; 4.12 ± 0.93 vs. 3.65 ± 0.63 days, p < 0.001). Additionally, the mean variations of surgical stress factors (C‐reactive protein and erythrocyte sedimentation rate) decreased significantly as the phase progress. The case number required for proficiency phase in benign and malignant tumor were 18 and 33, respectively, and lymph node resection posed a significant impact on the endpoint of the learning curve (p < 0.001). Meanwhile, the size of nodule showed no significant impact (p = 0.622). For right‐handed surgeons, 16 cases and 25 cases were required for technical competence in left‐sided and right‐sided lesions, respectively, and no significant difference reached (p = 0.266).ConclusionsTASSET has demonstrated safe and technically feasible with comparable oncological outcomes. Experience of 41 cases was required for surgical competence and proficiency. The initial learning stage could be more quickly adopted by high‐volume thyroid surgeons with standardized procedures.

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“…Yuda 2018 [50] Case series Using IONM systematically, the prediction of RLNP and detection of nerve injury points seem feasible.…”

Section: Author Type Of Article Outcomementioning

confidence: 99%

Recurrent Laryngeal Nerve Intraoperative Neuromonitoring Indications in Non-Thyroid and Non-Parathyroid Surgery

Brunet,

Rovira,

Quer

et al. 2024

JCM

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Introperative nerve monitoring (IONM) of the recurrent laryngeal nerve (RLN) is a well-established technique to aid in thyroid/parathyroid surgery. However, there is little evidence to support its use in non-thyroid or non-parathyroid surgery. The aim of this paper was to review the current evidence regarding the use of IONM in non-thyroid/non-parathyroid surgery in the head and neck and thorax. A literature search was performed from their inception up to January 2024, including the term “recurrent laryngeal nerve monitoring”. IONM in non-thyroid/non-parathyroid surgery has mainly been previously described in oesophageal surgery and in tracheal resections. However, there is little published evidence on the role of IONM with other resections in the vicinity of the RLN. Current evidence is low-level for the use of RLN IONM in non-thyroid/non-parathyroid surgery. However, clinicians should consider its use in surgery for pathologies where the RLN is exposed and could be injured.

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A Strategy for Using Intraoperative Nerve Monitoring During Esophagectomy to Prevent Recurrent Laryngeal Nerve Palsy

Abstract: In esophageal cancer surgery, identification of the RLN using IONM can be carried out safely, simply, and promptly. Using IONM systematically, the prediction of RLN palsy and detection of nerve injury point seems feasible.

Cited by 11 publications

References 23 publications

Efficacy of Intraoperative Recurrent Laryngeal Nerve Monitoring During Thoracoscopic Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-Analysis

Efficacy of Intraoperative Recurrent Laryngeal Nerve Monitoring During Thoracoscopic Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-Analysis

Learning curve of trans‐areola single‐site endoscopic thyroidectomy in a high‐volume center: A CUSUM‐based assessment

Recurrent Laryngeal Nerve Intraoperative Neuromonitoring Indications in Non-Thyroid and Non-Parathyroid Surgery

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