PS01.223: ‘ENERGY-LESS TECHNIQUE’ WITH MINI-CLIPS FOR RECURRENT LARYNGEAL NERVE LYMPH NODE DISSECTION IN PRONE THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

Abstract

Abstract Background Esophagectomy with radical mediastinal lymph node dissection remains the standard option for the curative treatment of esophageal squamous cell carcinoma. However, meticulous lymph node dissection along the recurrent laryngeal nerve (RLN), often results in recurrent laryngeal nerve paralysis (RLNP), leading to postoperative laryngopharyngeal dysfunction. Recently, thoracoscopic radical esophagectomy has been performed as a minimally invasive surgery for esophageal cancer. Although thoracoscopic surgery appears to reduce the risk of postoperative pulmonary complications and permits earlier postoperative recovery, the issue of postoperative RLNP remains unresolved. Methods We had attempted to simply cut the vessels around RLN sharply with scissors without using energy device in order to prevent RLN paralysis. However, these procedures often result in minor bleeding. Then we introduced the use of mini-clips for hemostasis before cutting the vessels with scissors. In this study, we analyzed data from 64 patients with esophageal cancer who underwent thoracoscopic esophagectomy in prone position. The patients were divided into two groups according to the period of operation: before and after the introduction of energy-less techniques with mini-clips. Surgical results were compared between the 2 groups. Results With regard to RLNP, the incidence was 24.0% in the before group; this incidence went down to 5.1% in the after group, after the introduction of energy-less techniques with mini-clips (P = 0.0259). Moreover, length of hospital stay after surgery was significantly shortened, from 36.1 days to 22.0 days, after the introduction of energy-less techniques with mini-clips (P = 0.0075). There were two operators performing thoracoscopic esophagectomy at our institution: surgeon A, a senior doctor with a 22-year career; and surgeon B, a junior doctor with a 12-year career. We compared all surgical results and found that there were no differences between the two doctors. Conclusion Our energy-less technique with mini-clips in RLN lymph node dissection could keep the surgical field dry by preventing minor bleeding. This contributed both to prevent RLNP and to shorten the patient's hospital stay. This technique was also considered useful for standardizing procedures within our institution, because special skills were not needed. Disclosure All authors have declared no conflicts of interest.