Abstract
PurposeThe 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.MethodsFrom 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.ResultsReliable 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.ConclusionIONM 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.
Highlights
IntroductionIn open thoracic esophagectomy with extended 2-field lymphadenectomy, the use of recurrent laryngeal nerve (RLN) monitoring was described as a useful method, which leads to a reduction of cases with postoperative vocal cord paresis [3, 6]
The use of intraoperative nerve monitoring (IONM) was shown to contribute to the identification of the recurrentLangenbecks Arch Surg (2020) 405:1091–1099 mechanically based respiratory insufficiency, which potentially requires tracheotomy [4, 5].In open thoracic esophagectomy with extended 2-field lymphadenectomy, the use of recurrent laryngeal nerve (RLN) monitoring was described as a useful method, which leads to a reduction of cases with postoperative vocal cord paresis [3, 6]
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]
Summary
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]. A more radical resection of upper mediastinal lymph nodes is facilitated by RAMIE, when compared with minimally invasive esophagectomy [13,14,15,16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
