Technique and surgical outcomes of mesenterization and intra-operative neural monitoring to reduce recurrent laryngeal nerve paralysis after thoracoscopic esophagectomy: A cohort study

Kobayashi, Hiroyuki; Kondo, Masato; Mizumoto, Motoko; Hashida, Hiroki; Kaihara, Satoshi; Hosotani, Ryo

doi:10.1016/j.ijsu.2018.05.738

Cited by 24 publications

(37 citation statements)

References 21 publications

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“…Unfortunately, the authors did not mention how the intraoperative ventilation was performed [12]. In addition, Kobayashi and colleagues demonstrated that IONM can significantly reduce RLN paralysis in esophageal cancer surgery and is associated with shorter postoperative hospital stay because of a lower rate of postoperative complications [13]. The most common method for IONM is the evoked laryngeal electromyography, which implies the stimulation of the recurrent laryngeal or the vagal nerve and consecutive recording of the EMG signal at the laryngeal muscles via laryngeal needle electromyography, laryngeal surface electrodes or special EMG ETT systems [10].…”

Section: Discussionmentioning

confidence: 99%

Combined recurrent laryngeal nerve monitoring and one-lung ventilation using the EZ-Blocker and an electromyographic endotracheal tube

Moritz

Schmidt

Schreiner

et al. 2019

J Cardiothorac Surg

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Background Intraoperative neuromuscular monitoring (IONM) is a widespread procedure to identify and protect the recurrent laryngeal nerve (RLN) during thyroid surgery. However, for left thoracic surgery with high risk of RLN injury, both reliable recurrent laryngeal nerve monitoring and one-lung ventilation could interfere. Methods In this prospective study, a new method for IONM during one-lung ventilation combining RLN monitoring with an electromyographic (EMG) endotracheal tube (ETT) and lung separation using the EZ-Blocker (EZB) is described and its clinical feasibility and effectiveness were assessed. Results A total of 14 patients undergoing left upper lobe surgery and left upper mediastinal lymph node dissection were enrolled. The EZB was introduced and positioned without any problems and sufficient lung collapse was achieved in all patients. No tracheobronchial injuries or immediate complications occurred. A stable EMG signal was present in all patients and no RLN palsy and no negative side effects of the NIM EMG ETT or the EZB were observed postoperatively. Conclusions The described method is technically feasible, easy to apply and save. It provides both reliable IONM and independent lung separation for optimal surgical exposure. The combined use of the EZB and the NIM EMG ETT might reduce the risk for RLN palsy and impaired lung separation during left thoracic surgery with high risk for RLN injury.

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Section: Discussionmentioning

confidence: 99%

Combined recurrent laryngeal nerve monitoring and one-lung ventilation using the EZ-Blocker and an electromyographic endotracheal tube

Moritz

Schmidt

Schreiner

et al. 2019

J Cardiothorac Surg

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“…Yet, thyroid redo-surgery leads to higher rates of [24], 4R lymph node station 4R according to [24], 7 lymph node station 7 according to [24] [30]. In esophageal surgery, the use of intraoperative nerve monitoring was shown to be associated with a reduction in the postoperative VCP rate, e.g., from 9.8 to 0% (p = 0.029) in open surgery and 32.1 to 9.7% (p = 0.03) in minimally invasive esophagectomy [6,7]. In 2012, Zhong et al reported an algorithm for IONM in open thoracic esophagectomy.…”

Section: Discussionmentioning

confidence: 95%

“…In open thoracic esophagectomy with extended 2-field lymphadenectomy, the use of RLN monitoring was described as a useful method, which leads to a reduction of cases with postoperative vocal cord paresis [3,6]. In minimally invasive (thoracoscopic) esophagectomy, the use of IONM for RLN detection before visual contact ("mapping") was proven to be associated with a reduction of the postoperative vocal cord paresis rate, when compared with esophagectomy without IONM support [7].…”

Section: Introductionmentioning

confidence: 99%

Recurrent laryngeal nerve monitoring during totally robot-assisted Ivor Lewis esophagectomy

Staubitz

Sluis

Berlth

et al. 2020

Langenbecks Arch Surg

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Purpose The robot-assisted approach for Ivor Lewis esophagectomy offers an enlarged, three-dimensional overview of the intraoperative situs. The vagal nerve (VN) can easily be detected, preserved, and intentionally resected below the separation point of the recurrent laryngeal nerve (RLN). However, postoperative vocal cord paresis can result from vagal or RLN injury during radical lymph node dissection, presenting a challenge to the operating surgeon. Methods From May to August 2019, 10 cases of robot-assisted minimally invasive esophagectomy (RAMIE) with extended 2-field lymphadenectomy, performed at the University Medical Center Mainz, were included in a prospective cohort study. Bilateral intermittent intraoperative nerve monitoring (IONM) of the RLN and VN was performed, including pre- and postoperative laryngoscopy assessment. Results Reliable mean signals of the right VN (2.57 mV/4.50 ms) and the RLN (left 1.24 mV/3.71 ms, right 0.85 mV/3.56 ms) were obtained. IONM facilitated the identification of the exact height of separation of the right RLN from the VN. There were no cases of permanent postoperative vocal paresis. Median lymph node count from the paratracheal stations was 5 lymph nodes. Conclusion IONM was feasible during RAMIE. The intraoperative identification of the RLN location contributed to the accuracy of lymph node dissection of the paratracheal lymph node stations. RLN damage and subsequent postoperative vocal cord paresis can potentially be prevented by IONM.

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“…It was reported that IONM could help the surgeon to identify and preserve the RLN before energy devices touch it. 72,73 Meanwhile, IONM is also very helpful in avoiding bilateral RLN palsy during surgery. The LNs along the right RLN are usually removed first in MIE; once IONM indicates an injury of the right RLN in the lymphadenectomy, the dissection of the left RLN nodes should be extremely careful or has to be abandoned to avoid catastrophic bilateral RLNs palsy.…”

Section: Rln Protection In Miementioning

confidence: 99%

Lymph node dissection and recurrent laryngeal nerve protection in minimally invasive esophagectomy

Wang

Mao

Gao

et al. 2020

Annals of the New York Academy of Sciences

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Until now, neoadjuvant therapy plus surgical resection of the primary tumor and potential metastatic lymph nodes (LNs) has been the current optimal treatment for locally advanced thoracic esophageal cancer (EC). LN metastasis is one of the most negative prognostic factors for thoracic esophageal squamous cell carcinoma (ESCC). However, the extent of LN dissection for thoracic ESCC has long been controversial worldwide. LNs along the recurrent laryngeal nerve (RLN) were reported to have the highest frequency of metastases in thoracic ESCC, so lymphadenectomy along the bilateral RLN is necessary but quite challenging because of a high frequency of recurrent nerve palsy and related postoperative complications. With the development of minimally invasive devices and techniques in recent years, minimally invasive esophagectomy (MIE) has been widely applied in EC surgery. The topics of what the optimal extent of lymphadenectomy is and how the recurrent nerve should be well protected during MIE have been debated in recent years. The purpose of our review is specifically to address the patterns of LN metastasis, the extent of LN dissection, and the protection of the RLN in MIE for thoracic ESCC.

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Technique and surgical outcomes of mesenterization and intra-operative neural monitoring to reduce recurrent laryngeal nerve paralysis after thoracoscopic esophagectomy: A cohort study

Abstract: The combination of IONM and the concept of the mesoesophagus have substantial advantages in allowing accurate and safe mediastinal lymphadenectomy during prone esophagectomy.

Cited by 24 publications

References 21 publications

Combined recurrent laryngeal nerve monitoring and one-lung ventilation using the EZ-Blocker and an electromyographic endotracheal tube

Combined recurrent laryngeal nerve monitoring and one-lung ventilation using the EZ-Blocker and an electromyographic endotracheal tube

Recurrent laryngeal nerve monitoring during totally robot-assisted Ivor Lewis esophagectomy

Lymph node dissection and recurrent laryngeal nerve protection in minimally invasive esophagectomy

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