Recurrent laryngeal nerve monitoring during totally robot-assisted Ivor Lewis esophagectomy
| Autor: | Felix Watzka, Hauke Lang, Julia I. Staubitz, A Läßig, Peter P. Grimminger, F Dette, Thomas J. Musholt, Felix Berlth, P C van der Sluis |
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| Rok vydání: | 2020 |
| Předmět: |
Larynx
medicine.medical_specialty Esophageal Neoplasms medicine.medical_treatment Laryngoscopy Esophageal cancer 610 Medizin Intraoperative nerve monitoring 03 medical and health sciences 0302 clinical medicine 610 Medical sciences Monitoring Intraoperative medicine Recurrent laryngeal nerve Humans Robot-assisted surgery Prospective Studies Paresis medicine.diagnostic_test business.industry Recurrent Laryngeal Nerve Paratracheal lymph nodes Radical Lymph Node Dissection Robotics Surgery Esophagectomy medicine.anatomical_structure 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Lymphadenectomy Original Article medicine.symptom Vocal cord paresis business |
| Zdroj: | Langenbeck's Archives of Surgery |
| ISSN: | 1435-2451 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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