Rate Of Palsy Research Articles

Recurrent laryngeal nerve lymph node dissection with subcomplete sealing using advanced bipolar energy device in minimally invasive esophagectomy

AbstractIntroductionRecurrent laryngeal nerve (RLN) palsy is a complication that must be avoided during esophagectomy. While RLN injury is thought to be caused by thermal spread from electric devices, electric devices are useful to avoid bleeding. When dissecting lymph nodes around RLNs, to seal small vessels, we use subcomplete technique with advanced bipolar. We describe our surgical technique, termed the subcomplete sealing technique, in RLN lymph node dissection.Materials and Surgical TechniqueThe first step is to perform blunt dissection with forceps on both sides of the esophageal branch near the right RLN. A distance of at least 2 mm from the RLN was preferred. Sealing with advanced bipolar often causes tissue shrinkage, pulling the RLN near the device. To prevent this, sealing should be stopped before reaching completion. Although the sealing was not complete, it was sufficient to seal the small vessels. After subcomplete sealing, the sealed tissues were dissected using laparoscopic scissors. The lymph nodes around left RLN are dissected in the same manner.DiscussionA total of 76 patients received esophagectomy with the subcomplete technique. Grade IIIa RLN palsy occurred in three cases (3.95%). Over Grade IIIb RLN palsies did not occur. This subcomplete sealing technique can assist surgeons in performing RLN lymph node dissection without bleeding and increasing the rate of RLN palsy.

Demographic toxicology of insect growth regulators on the nontarget ectolarval parasitoid Habrobracon hebetor

Habrobracon hebetor Say (Hymenoptera: Braconidae) is one of the most important parasitoids of many pyralid moths, including the olive leaf moth, Palpita unionalis Hubner (Lepidoptera: Pyralidae). The widespread use of insecticides threatens natural enemies. Assessing the side effects of insecticides on nontarget organisms supports the rational use of insecticides during field application. The present study evaluates the lethal and sublethal effects of three insect growth regulators (IGRs), novaluron, methoxyfenozide, and pyriproxyfen, on P. unionalis and the demographic toxicology of these IGRs on its parasitoid H. hebetor. The LC50 values of these IGRs on P. unionalis were 0.97, 0.176, and 0.00009 ppm, respectively, indicating that pyriproxyfen was the most toxic. When H. hebetor adults were exposed to these LC50 levels under laboratory conditions to determine possible side effects. The IGRs did not affect the paralysis and parasitism rates of the parasitoid nor the sex ratio of its offspring. IGR treatments slightly reduced hatching rates and immature survival by 15–25%, indicating moderate effects on the early developmental stages of H. hebetor. The longevity and fecundity of treated females were each reduced to < 50% of their respective values in untreated females. Additionally, some demographic parameters of the parasitoid were significantly affected by the IGRs. Nevertheless, despite these observed effects, the positive net reproductive rate (R0 > 0) and intrinsic rate of increase (rm > 1) of H. hebetor indicated an exponential population increase that reflects the compatibility of the IGRs with the parasitoid. Our results demonstrated that the tested IGRs could be categorized as relatively harmless compounds to the parasitoid. Following these laboratory assessments, field studies will be required to confirm the effects of the tested IGRs on H. hebetor as well as other nontarget organisms.

Enhancing Global Poliomyelitis Surveillance Performance is Crucial for Eradication Efforts

Background: Poliomyelitis remains a significant public health challenge, with global efforts focused on its eradication. One critical strategy in this endeavor is the implementation of an acute flaccid paralysis (AFP) surveillance system, which is essential for early detection and response to poliovirus transmission. Specific Background: Despite the system's importance, there is limited evaluation of its performance, particularly in regions like Diyala province, Iraq. Knowledge Gap: Previous studies have not adequately assessed the AFP surveillance performance indicators specific to this region, necessitating a comprehensive analysis. Aims: This study aimed to evaluate the performance indicators of the AFP surveillance system in Diyala province during 2021, utilizing established World Health Organization (WHO) standards. Results: The cross-sectional study analyzed data from seven primary health care centers. Key findings revealed a Non-Polio Acute Flaccid Paralysis rate of 5.11 per 100,000 children under 15 years. Performance indicators included 100% reporting completeness, 95% timeliness of notification and investigation, and 97% stool quality for laboratory analysis. Furthermore, 97.3% of specimens reached the national laboratory within three days, demonstrating high operational efficiency. Novelty: This study is one of the first to provide a detailed evaluation of the AFP surveillance system in Diyala province, highlighting areas of strength and compliance with WHO targets. Implications: The findings underscore the effectiveness of the AFP surveillance system in this region, suggesting that its continued implementation can significantly contribute to the global eradication efforts of poliomyelitis while also serving as a model for similar evaluations in other regions. Highlights: High reporting completeness and timeliness in AFP surveillance. Non-Polio AFP rate exceeds WHO targets, indicating effective monitoring. Study supports global efforts toward poliomyelitis eradication. Keywords: Poliomyelitis, Acute Flaccid Paralysis, Surveillance System, Performance Indicators, Iraq

Outcomes of a modified technique of partial parotidectomy and novel parotid tumour position classification from a single surgeon prospective database.

Conservative parotidectomy for benign tumours reduces facial nerve palsy, without increasing local recurrence. We report a modified technique of partial parotidectomy and using a novel description of tumour position, explore relationships between tumour position and histological margins, facial nerve palsy and local recurrence. A prospectively collected single surgeon parotidectomy database was analysed, including tumour location (superficial/deep lobe; central/peripheral) and outcomes. A partial parotidectomy identified the facial nerve and the proximal portion of its branches with a macroscopically clear resection margin. Mean follow up was 5.9 years for pleomorphic adenomas. Three hundred and three patients underwent parotidectomy; 257 (84.8%) were superficial and 46 (15.2%) deep lobe. Tumour position was recorded in 291: 236 (81.1%) were peripheral tumours and 55 (18.9%) central. Histological margin involvement was similar in central and peripheral tumours, both overall and for superficial and deep lobe tumours, but was commoner in central deep lobe tumours, (P = 0.003). Temporary partial facial nerve palsy occurred in 21 (6.9%), with one permanent partial nerve palsy (0.3%). Deep lobe tumours and total parotidectomy were associated with facial nerve palsy (P = 0.01). Facial nerve monitoring reduced the risk of palsy (P < 0.01). Local recurrence of pleomorphic adenomas was uncommon, occurring in 3 (2.0%) of 151 patients. This series confirms the safety and adequacy of more conservative partial parotidectomy for benign tumours, highlighting most tumours are peripheral, but not more prone to histological margin involvement or local recurrence, and with routine intraoperative facial nerve monitoring, is achieved with low facial nerve palsy rates.

A prospective observational study on the anatomical variations of recurrent laryngeal nerve and its application in the prevention of injury during thyroid surgery in a tertiary care centre

BackgroundThyroid gland is the largest and most vascular structure among the endocrine glands. The recurrent laryngeal nerve and the superior laryngeal nerve are closely related to the thyroid gland; these nerves control voice and are vital in breathing. Anatomical preservation of the recurrent laryngeal nerve (RLN) is the gold standard in thyroid surgery. Visual identification of RLN has decreased the rates of permanent RLN palsy during thyroid and parathyroid operations. Prior knowledge about the branching patterns will help in predicting and preventing injury to the nerve during thyroid surgery.Aim and objectivesThe aim of the study is to observe the terminal branching pattern of recurrent laryngeal nerve before its entry into the larynx.MethodsAn observational study with 50 participants who fulfilled the inclusion and exclusion criteria were enrolled in the study. After a complete evaluation and pre-anaesthetic checkup, the patients were operated and intraoperative findings of RLN branching were recorded and compared for the study.ResultsIn our study, out of the 50 patients who underwent thyroid surgery during the course of the study, right-sided RLN branching was demonstrated in 25 patients (21 right hemithyroidectomy and 4 total thyroidectomy). Ten patients had RLN bifurcation, 7 had trifurcation, 5 had numerous branches, and 3 with no branching pattern were noted. Similarly, out of 29 patients (25 left hemithyroidectomy and 4 total thyroidectomy) in whom left-sided RLN branching was studied, bifurcation was seen in 10 patients, trifurcation in 12 patients, and multiple branching was observed in 7.ConclusionThe anatomical variations seen in RLN may increase the risk of vocal cord palsy due to its injury. Anatomical variations are categorized according to the original direction of the RLN and the number of terminal branches in the larynx. This classification aids in the identification and preservation of its branches, hence facilitating a safer thyroidectomy.

Implication of surgical loupes on complications following thyroidectomy: a meta-analysis.

To determine the effectiveness of surgical loupes in reducing postoperative RLN palsy and hypocalcemia following thyroidectomy. PubMed, Scopus and Google Scholar databases were searched between 2000 and 2024. Studies were included if they reported at least one complication outcome following thyroidectomy using surgical loupes. The outcome measure was the log odds ratio, with negative log odds indicating results favouring the experimental group. The model utilized the DerSimonian-Laird estimator, and Wald-type tests. The qualitative data synthesis included 813 patients from 6 included studies, including 410 patients with surgical loupes and 403 patients without surgical loupes. There was a statistically significant reduction in the rate of temporary RLN palsy in the surgical loupe group log(OR) = - 0.87 [(- 1.58, - 0.15), DL (Dersimonian and Laird method), REM (random effects model), CI (confidence interval) = 95%], or a 41.8% lower probability. The rates of permanent RLN palsy log(OR) = - 0.31 [(- 1.45, 0.82), DL, REM, CI = 95%], temporary hypocalcemia log(OR) = - 0.34 [(- 1.25, 0.57), DL, REM, CI = 95%], and permanent hypocalcemia log(OR) = - 0.85 [(- 2.24, 0.54), DL, REM, CI = 95%] were not statistically significant between the two groups, although there were trends toward decreases in these rates in the loupes group. Surgical loupe use during thyroidectomy can lead to a 41.8% lower probability of temporary RLN palsy compared to operating without loupes. 3a.

Single-Port da Vinci Robot-Assisted Cervical Esophagectomy: How to Do It.

Minimally invasive esophagectomies, including robot-assisted procedures, have demonstrated superiority over traditional open surgery. Despite the prevalence of transhiatal and transthoracic approaches, cervical access is less common in minimally invasive esophageal surgery. Advancements in robotic systems, such as the da Vinci Single Port (SP), enable controlled transcervical extrapleural mediastinoscopic access, potentially reducing pulmonary complications and extending surgical options to patients with comorbidities. The da Vinci SP robot-assisted cervical esophagectomy (SP-RACE) employs an SP and laparoscopic approach, demonstrating feasibility with comparable lymphadenectomy and recurrent nerve palsy rates to transthoracic methods. This technique, performed for the first time in Europe at the University Hospital Mainz, involves a transcervical SP phase that allows for effective mediastinal dissection and esophageal mobilization. Despite technical challenges due to limited space, robotic systems enhance controlled access and eliminate arm collision. The da Vinci SP platform's advantages include improved triangulation, fewer interferences, and better control of instruments in confined spaces. This novel approach shows promise for patients with high esophageal tumors and those unsuitable for transthoracic surgery, warranting further investigation into its clinical utility and reproducibility.

Central Neck Dissection in Papillary Thyroid Carcinoma: Benefits and Doubts in the Era of Thyroid Lobectomy.

Surgery is still the main line of treatment for papillary thyroid cancer (PTC) with a current trend for de-intensified treatment based on an excellent prognosis. The role of a routine prophylactic central neck dissection (PCND) is still debated as its impact on oncologic outcomes has never been cleared by a randomized clinical trial. In this study, we aimed to report our long-standing experience in PCND and its potential contemporary role in the treatment of PTC. A retrospective institutional review was performed on all patients who underwent operation for PTC including PCND between 1998 and 2021. The primary outcomes were the rate of central lymph node metastases (CLNMs), cancer recurrence and incidence of complications. Survivals were analyzed using the Kaplan-Meier estimator and Cox proportional hazard models. A total of 657 patients were included in this study with a median follow-up of 78 months (48-114 months). Two hundred and one patients presented occult CLNMs (30.6%). The presence of a pathological node represented the unique reason for a completion thyroidectomy and I131 therapy in 12.5% of the population. Age lower than 55 years, microscopic or macroscopic extra-thyroid extension (ETE) and multifocality were independent factors predicting CLNMs. The rate of recurrence in the whole population was 2.7% (18 patients). Five-year and ten-year disease-free survival (DFS) was 96.5% (94.7-97.7) and 93.3% (90.3-95.5), respectively. Two patients relapsed in the central neck compartment (0.3%). Age (>55 years), pathological staging (pT) and extranodal extension (ENE) were independent factors associated with a worse DFS. The rate of temporary and permanent vocal fold palsy was 12.8% and 1.8%, respectively, and did not depend on the type of surgical procedure performed. Hypoparathyroidism was temporary in 42.2% and permanent in 11.9% of the patients. A sub-analysis upon cT1b-T2 patients treated primarily with thyroid lobectomy and ipsilateral PCND demonstrated a 2.6% rate of permanent hypoparathyroidism. PCND allows for a high disease-free survival and a proper selection of patients needing adjuvant treatment, in particular, those treated with a unilateral procedure. On the other hand, bilateral approach is burdened by a not-neglectable rate of permanent hypoparathyroidism.

Efficacy and safety of atrial fibrillation ablation in patients with aged 80 years or older.

Atrial fibrillation (AF) is the most common cardiac arrhythmia observed in the elderly. Its prevalence rises with age, particularly in individuals over 80 years old. While catheter ablation has emerged as a first line therapy for the patients with symptomatic AF, evidence on its application in elderly patients remains controversial. This study aimed to assess safety and efficacy outcomes of AF ablation in patients aged ≥ 80 years.Consecutive 1327 patients who underwent a first pulmonary vein isolation (PVI) for AF were retrospectively analyzed. Patients aged ≥ 80 years (elderly group, n = 107) were compared with patients aged < 80 years (younger group, n = 1220). At 1-year follow-up, there was no significant difference in AF free rate between the elderly and the younger group (72.0% vs. 73.9%, P = 0.786). Regarding major complications, the elderly patients had a greater incidence of periprocedural stroke (1.9% vs. 0.1%, P = 0.018). The rates of cardiac tamponade, phrenic palsy, and vascular complications were not significantly different between the 2 groups.PVI for AF is effective in patients aged ≥ 80 years with a similar success rate, but periprocedural stoke risk was higher compared to the younger population.

Network Pharmacology Analysis and Retrospective Cohort Study Revealing the Effect of Qingyi Decoction on Intestinal Paralysis in Patients with Severe Acute Pancreatitis.

Intestinal dysfunction plays an important role in the clinical progress and prognosis of severe acute pancreatitis (SAP). Qingyi decoction (QYD) has shown beneficial effects on intestinal function recovery, but the prevention actions of the QYD on intestinal paralysis and its mechanism have not been fully explored. The possible molecular mechanism was unraveled by network pharmacology, including active ingredients and potential target prediction, as well as GO, KEGG, and REATCOME pathway enrichment analyses. The potential interactions between the main active ingredients of the QYD and core genes were explored by molecular docking. A retrospective cohort study on 137 patients with SAP from Tianjin Nankai Hospital was conducted to evaluate the preventive effect of QYD on intestinal paralysis. A total of 110 active ingredients in QYD were screened out, and 37 key targets were predicted by network pharmacology. GO, KEGG, and REATCOME enrichment analyses showed that bioinformatics annotation of the hub genes was mainly involved in intestinal epithelial functions and inflammatory response pathways. The main components of QYD possessed good affinity with IL-6, TNF, CASP3, CXCL8, and CRP by molecular docking. Patients who used QYD plus usual care seemed to have fewer intestinal paralysis rates, lower risk of renal insufficiency, ARDS and blood purification therapy, and shorter hospital and ICU stays. The multivariable regression analyses indicated that the mode of nasogastric and enemas administration of QYD (P = 0.010) and timely intervention with QYD (P = 0.045) were the independent protective factors for intestinal paralysis prevention in patients with SAP. In conclusion, QYD can be used as an effective adjuvant procedure to prevent the occurrence and development of intestinal paralysis in patients with SAP. The mechanisms may be involved in the anti-inflammatory response and maintenance of intestinal epithelial function.

Bell's palsy and COVID-19: A cohort study with historical rate comparison

IntroductionDuring the SARS-CoV-2 pandemic, immune-mediated neurological events have been described in patients vaccinated against the virus or who have overcome the disease. Among these events is Idiopathic peripheral facial palsy or Bell’s palsy. ObjectivesTo study the incidence of Bell's Palsy in the ENT emergency department of a tertiary hospital in Catalonia during the SARS-CoV-2 pandemic. MethodsRetrospective historical cohort comparison study of patients diagnosed with Bell's palsy between January 2018 and December 2021. Crude incidence rates were calculated as the total number of events divided by person time at risk per 100.000 person-years. Observed (2020, 2021) and historical (2018, 2019) rates were compared using standardized incidence rates with corresponding 95% confidence intervals. ResultsOf the total number of ENT emergency department visits from 2018 to 2021 (22.658), there were 247 cases of Bell's palsy. The incidence rate of Bell's palsy in the pre-pandemic group was 12,2 and 10,9 per 100.000 person-years for 2018 and 2019, respectively. The 2020 standardized incidence rate of Bell's palsy was 0,70 [95% CI 0,49–1,01] and 1,25 [95% CI 0,93–1,67] for 2021. No significant differences were evident between the two groups. ConclusionIn our cohort, no association was found between vaccination or COVID-19 infection and the development of Bell's Palsy.

572. TECHNICAL DETAIL AND SHORT-TERM OUTCOMES OF ROBOT-ASSISTED CERVICAL ESOPHAGECTOMY (RACE) WITH BILATERAL CERVICAL APPROACH FOR ESOPHAGEAL CANCER

Abstract Background The transcervical mediastinoscopic esophagectomy is a relative new technique that has gradually demonstrated because of its ease of dissection along the organ sheath and its less invasive nature. However, the conventional cervical approach to mediastinoscopy has been reported to have a relatively high rate of recurrent nerve palsy due to interference in the mediastinum caused by the straight forceps. The robot-assisted transcervical esophagectomy (RACE) approach is novel procedure expected to reduce these interferences and improve maneuverability around the recurrent nerve. In this report, we describe a surgical technique and short-term outcome of RACE. Methods In this study, we included 26 RACE cases performed between Feb 2023 to Feb 2024. Principally, our hospital performs transcervical esophagectomy mainly on patients who are difficult to approach by transthoracic approach due to history of thoracic diseases, etc. In our department, transcervical esophagectomy is usually performed via a bilateral cervical approach, starting from the right neck and continuing to the left neck, and RACE is performed using the da Vinci Xi via a bilateral cervical approach as well. Recently, we have been shortening the operation time by performing simultaneous cervical and abdominal operations without muscle relaxation using NIM. Results Patient background: mean age 74.5, male to female ratio 22:4, cStage I/II/III/IV: 13/3/9/1, NAC: 46.1%, more than 80% had some history of pulmonary disease/systemic history. All patients underwent RACE via bilateral cervical approach, and no intraoperative complications or thoracoscopic conversion were observed. Postoperative complications (CD Grade≥1) included recurrent nerve palsy in 15.6% and respiratory complications in 7.6%. In addition, the recent operation with simultaneous cervical/abdominal NIM and no muscle relaxant has significantly shortened the average total operative time to 4 hours and 40 minutes. Conclusion Robot-assisted Cervical Esophagectomy (RACE) is a relatively safe procedure that offers a natural anatomic approach, fewer respiratory complications, and a significant reduction in operative time due to simultaneous neck and abdominal manipulation. With the advancement of robotics and devices, RACE is expected to become more effective and more widely used in the future.

220. SHORT-AND LONG-TERM OUTCOMES OF ROBOT ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A PROPENSITY SCORE-MATCHED STUDY

Abstract Background Conventional minimally invasive esophagectomy (C-MIE) for esophageal cancer has become widespread and standardized. In Japan, robot-assisted MIE (RAMIE) has been covered by national health insurance since 2018. However, the superiority of RAMIE over conventional MIE remains controversial. In this study, we will clarify the short-and long-term outcomes of RAMIE compared to C-MIE. Methods Short-term outcomes were compared using propensity score-matching (PSM) for C-MIE group (324 cases) and RAMIE group (101 cases) performed from 2010 to 2023. Long-term outcomes were compared using PSM for C-MIE group (313 cases) and RAMIE group (69 cases) up to 2021, when a minimum three-year observation period was available. Covariates for PSM were age, sex, tumor location, histological type, cT, cN, preoperative treatment, abdominal approach, and range of lymph node dissection. Results For short-term outcomes, 96 cases were included in each group after PSM. There were no significant differences in age, sex, tumor location, histological type, cT, cN, and preoperative treatment. Operative time was significantly longer in RAMIE group than in C-MIE group (overall procedure: 657 vs. 764 min, P&amp;lt;0.001; thoracic prpcedure: 306 vs. 411 min, P&amp;lt;0.001). Blood loss was significantly lower in RAMIE group than in C-MIE group (145 vs. 64 ml, P&amp;lt;0.001). The rate of recurrent laryngeal nerve palsy (Clavien-Dindo classification, Grade II or higher) was significantly lower in RAMIE group than in C-MIE group (10% vs. 0%, P&amp;lt;0.001). There were no significant differences in the rates of anastomotic leakage and postoperative pneumonia between both groups (P=0.159, 0.709). For long-term outcomes, 69 cases were included in each group after PSM. The 3-year overall survival rate was 70.8% in C-MIE group and 77.1% in RAMIE group, and the 3-year disease-free survival rate was 63.5% in C-MIE group and 58.8% in RAMIE group, both showing no significant difference (P=0.406, P=0.651). Conclusions RAMIE has the potential to reduce recurrent laryngeal nerve palsy compared to C-MIE and long-term outcomes for both procedures were comparable.

Surgical and anesthetic considerations in a unique case of temporary iatrogenic facial nerve paralysis after superficial parotidectomy

Parotid neoplasms are a common indication for parotidectomy, a procedure that carries a risk of facial paralysis. Modern advances in surgical and anesthesia techniques, including facial nerve monitoring have resulted in low rates of permanent facial nerve paralysis. We present a case of temporary postoperative right facial nerve paralysis after intact facial nerve neuromonitoring at the completion of resection. The proposed mechanism of this phenomenon is related to the effects of local anesthetic infiltration from a fat graft used for oncologic reconstruction. This case emphasizes the importance of judicious and carefully timed local anesthetic use, clear facial nerve monitoring, and coordination between care teams.

588. EFFICACY OF INTRAOPERATIVE RECURRENT LARYNGEAL NERVE MONITORING DURING MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A NATIONWIDE INPATIENT COHORT STUDY

Abstract Background Lymphadenectomy around the recurrent laryngeal nerve (RLN) is an essential part of curative surgery for esophageal cancer. The rate of lymph node metastasis around the RLN is extremely high, and postoperative RLN palsy could lead to a poor prognosis in patients with esophageal cancer. Although several single-center studies have shown that intraoperative nerve monitoring (IONM) can avoid RLN palsy, this has not been confirmed in a large-scale multicenter study. This study was performed to evaluate whether intraoperative nerve monitoring IONM can reduce postoperative RLN palsy during minimally invasive esophagectomy (MIE) for esophageal cancer using a national database. Methods We retrieved data of patients with esophageal cancer who underwent MIE involving thoracoscopic or robotic esophagectomy with IONM (502 patients) and without IONM (4,353 patients) at 348 hospitals from April 2020 to March 2022 from the Diagnosis Procedure Combination database in Japan. We compared the frequency of postoperative RLN palsy and respiratory complications between the IONM (+) group and IONM (−) group using propensity score-matching (PSM) analysis. The propensity score was estimated using multivariable logistic regression models including age, sex, Body Mass Index, Brinkman index, Activities of Daily Living, comorbidities at admission, clinical TNM classification, approach of MIE, and hospital case volume with reference to previous studies of IONM. Results After PSM, the standardized bias was &amp;lt;10% for all covariates, which indicated improved balance in the covariates between the matched pairs. With 1-to-1 matching, 501 pairs (1,002 cases) were created between the IONM (+) and (−) groups. The postoperative RLN palsy rate was significantly lower in the IONM (+) than (−) group (odds ratio, 0.24; 95% confidence interval [CI], 0.13–0.46). The respiratory complication rate was also significantly lower in the IONM (+) than (−) group (odds ratio, 0.66; 95% CI, 0.45–0.97). The anesthesia time was significantly longer in the IONM (+) group (regression coefficient, 60.1 minutes; 95% CI, 44.2–76.9). The length of postoperative hospitalization tended to be shorter in the IONM (+) than (−) group (regression coefficient, −1.39 days; 95% CI, −3.91 to 1.14). Conclusion This nationwide cohort study showed that IONM during MIE for esophageal cancer can reduce postoperative RLN palsy and respiratory complications.

395. SUPERIOR PERFORMANCE OF ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY OVER THORACOSCOPIC APPROACH: A MULTI-INSTITUTIONAL STUDY ON SHORT-TERM OUTCOMES

Abstract Background Robot-assisted minimally invasive esophagectomy (RAMIE) and conventional minimally invasive esophagectomy (CMIE) are superior to open techniques. However, few studies have directly compared the outcomes of these two approaches. Methods A retrospective study was conducted on a dataset from six medical centers, encompassing patients with esophageal squamous cell carcinoma (ESCC) who underwent minimally invasive esophagectomy between 2015 and 2022. Perioperative outcomes were compared after applying inverse probability of treatment weighting (IPTW). Results The study included 577 patients (RAMIE, 206; CMIE, 371). After applying IPTW, RAMIE was found to yield a higher number of mediastinal nodes compared to CMIE (14.86 versus 12.66, p=0.017). RAMIE was notably effective in retrieving upper mediastinal left RLN nodes, averaging 1.97 nodes versus 1.14 nodes harvested by CMIE (p&amp;lt;0.001). This was coupled by a significant decrease in nerve palsy rates (13.9% versus 22.8%, p=0.020). A significantly larger percentage of patients in the RAMIE group had an uncomplicated postoperative course (51.8% versus 34%, p&amp;lt;0.001). RAMIE also led to a reduction in pneumonia rates (8.6% versus 15.2%, p=0.041) and was linked to a shorter length of stay (LOS; 16.64 versus 21.14 days, p=0.007). The advantage of RAMIE in reducing LOS was especially pronounced in patients with a high Charlson comorbidity index (mean difference, 8.46 days; p=0.0069) and those who underwent preoperative therapy (mean difference, 5.63 days; p&amp;lt;0.001). Conclusion In ESCC, the use of RAMIE led to fewer pneumonia and faster recovery compared to CMIE. Additionally, RAMIE significantly improved the feasibility and safety of performing LND along the RLN.

222. LONG-TERM SURVIVAL OF ROBOT-ASSISTED ESOPHAGECTOMY AND ITS UTILITY IN TREATING CT4B ESOPHAGEAL CANCER

Abstract (Background) Robot-assisted esophagectomy (RAMIE) has lately been introduced to many hospitals after its insurance approval. However, long-term outcome of RAMIE or its utility in treating cT3br-T4 esophageal cancer remains unclear. (Methods) A total of 188 esophageal cancer patients who underwent RAMIE between 2017 and 2022 were eligible in the present study. Among them, 20 cases with cT3br-T4 were reviewed to evaluate short-term outcome. Also, a comparison between RAMIE (n=66) and VATS (n=277) group with 2-year and longer follow-up time was made to evaluate their long-term outcomes. (Results) Background factors; age=71 (42-86), gender (M/F)= 145/43, tumor location (Ut/Mt/Lt, Ae)= 25/84/79, cT1/2/3/4= 36/31/101/20, cN0/1/2/3= 65/82/34/7, cM0/1= 155/33, and preoperative treatment (none/chemo/CRT/both)= 39/139/10. Surgical outcomes; operation time = 508 (273-833) min, console time=244 (108-479) min, estimated blood loss= 130 (0-2090) ml, overall postoperative morbidity (CD classification≧grade2) = 53.2% (pneumonia= 29.3%, atelectasis=9.0%, palsy of recurrent laryngeal nerve=10.1%, surgical site infection=5.9%, chylothorax=5.9%, and anastomotic leakage=5.9%). Postoperative hospital stay was 21 (12-385) days. The palsy rate of recurrent laryngeal nerve decreased from 9.1 to 0.7% after introducing intraoperative continuous nerve monitoring (NIM). In terms of RAMIE for cT3br-T4 cases (n=20), no convert to open or intraoperative complications were observed while all cases achieved R0 resection. Regarding survival comparison between the RAMIE (n=66) and the VATS (n=277) group, disease-free and overall survival were 74.8 vs 70.9% (P=0.4582), 76.4 vs 78.5% (p=0.7626), respectively. (Conclusion) NIM system reduced the palsy of recurrent laryngeal nerve during RAMIE while the comparable survival was identified between the two groups. Given its advantage, RAMIE seems to be particularly useful in treating cT3br-T4 cases. Our surgical videos of cT3br-T4 cases will be also presented in the meeting.

Effectiveness and feasibility of nerve real-time monitoring and intermittent monitoring in endoscopic thyroidectomy: A multicenter retrospective cohort study of 1621 patients.

Protecting recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN), a crucial indicator for assessing the quality of thyroid surgery, poses a challenge in endoscopic thyroidectomy. The aim of this study was to investigate the effectiveness and feasibility of nerve real-time monitoring and intermittent monitoring in endoscopic thyroidectomy. In this retrospective cohort study, patients underwent endoscopic thyroidectomy were included, and the characteristics and outcomes of real-time monitoring and intermittent monitoring groups were compared. Thereafter, the outcomes of four surgical types (unilateral lobectomy, total thyroidectomy, unilateral lobectomy + lymph node dissection (LND), and total thyroidectomy + LND) were compared in both groups. A total of 1621 patients were enrolled. Compared to intermittent monitoring group, real-time monitoring group significantly shortened operation durations in the four surgical types (30.8 ± 6.1 min vs. 35.7 ± 5.7 min, 54.7 ± 4.4 min vs. 59.1 ± 5.2 min, 39.3 ± 4.6 min vs. 42.0 ± 4.7 min, 59.1 ± 4.9 min vs. 66.0 ± 5.8 min, respectively). As for surgical complications, compared to intermittent monitoring group, real-time monitoring group had lower rates of transient vocal cord paralysis among the four surgical types (0.0% vs. 3.3%, 0.0% vs. 4.0%, 0.8% vs. 3.2%, 2.8% vs. 6.7%, respectively), and lower rates of EBSLN injury (1.1% vs. 4.4%, 0.0% vs. 12.0%, 0.8% vs. 3.8%, 0.9% vs. 4.8%, respectively). Clinicopathologic characteristics and postoperative inflammatory reactions were similarly paralleled in both groups. Implementation of real-time monitoring in endoscopic thyroidectomy effectively protects the RLN and EBSLN while shortening operation duration, demonstrating its feasibility and efficacy in enhancing nerve protection and surgical efficiency.

Intraoperative Recurrent Laryngeal Nerve Monitoring for Esophagectomy: A National Cohort Study

BackgroundLymphadenectomy around the recurrent laryngeal nerve (RLN) is an essential part of curative surgery for esophageal cancer. Although several single-center studies have shown that intraoperative nerve monitoring (IONM) can avoid RLN palsy, this has not been confirmed in a large-scale multicenter study. This study used a national database to evaluate whether IONM can reduce postoperative RLN palsy during minimally invasive esophagectomy (MIE) for esophageal cancer. MethodsWe retrieved data of patients with esophageal cancer who underwent 3-field thoracoscopic or robotic MIE with cervical anastomosis with IONM(+) (502 patients) and without IONM(−) (4353 patients) from April 2020 to March 2022 from the Diagnosis Procedure Combination database in Japan. We used propensity score-matching analysis to compare the frequency of postoperative RLN palsy and respiratory complications between the IONM(+) group and IONM(−) group. ResultsThe postoperative RLN palsy rate was significantly lower in the IONM(+) than IONM(−) group (odds ratio, 0.24; 95% CI, 0.13-0.46). The respiratory complication rate was also significantly lower in the IONM(+) than in the IONM(−) group (odds ratio, 0.66; 95% CI, 0.45-0.97). The anesthesia time was significantly longer in the IONM(+) group (regression coefficient, 60.1 minutes; 95% CI, 44.2-76.9 minutes). The length of postoperative hospitalization tended to be shorter in the IONM(+) than in the IONM(−) group (regression coefficient, −1.39 days; 95% CI, −3.91 to 1.14). ConclusionsThis national cohort study showed that IONM during 3-field MIE for esophageal cancer was associated with a reduction of postoperative RLN palsy and respiratory complications.

Determination of the Optimal Volume of 0.5% Ropivacaine in Single-Injection Retroclavicular Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Phase I/II Trial.

A brachial plexus block plays an important role in providing perioperative analgesia for shoulder surgery; however, the inherent risk of phrenic nerve block and resulting hemidiaphragmatic paralysis may limit its use in patients with compromised pulmonary function. This study aimed to evaluate safety, efficacy, the maximum tolerated volume, and the optimal biological volume of 0.5% ropivacaine used in a single-injection retroclavicular brachial plexus block for arthroscopic shoulder surgery. In this seamless single-arm exploratory phase I/II trial, a novel Bayesian optimal interval design was used to guide volume escalation for determination of the maximum tolerated volume, followed by sequential volume expansion using Bayesian optimal phase 2 design to establish the optimal biological volume. Fifty-four patients who underwent arthroscopic shoulder surgery received a single-injection retroclavicular brachial plexus block with 0.5% ropivacaine ranging from 15 mL to 40 mL. The primary outcomes were complete or partial hemidiaphragmatic paralysis in phase I, measured using ultrasound 30 min after block completion, and the block success in phase II, defined as achieving a total sensorimotor score ≥12 points and the total sensory score ≥3, measured through manual sensorimotor testing. The maximum tolerated volume for the single-injection retroclavicular brachial plexus block was determined to be 35 mL of 0.5% ropivacaine, with a hemidiaphragmatic paralysis rate of 0.09 (95% credible interval, 0 to 0.29). The optimal biological volume was found to be 25 mL, with a block success rate of 1.0 (95% credible interval, 0.95 to 1.0) and a negligible hemidiaphragmatic paralysis rate of 0.01 (95% credible interval, 0 to 0.06). A single-injection retroclavicular brachial plexus block using 25 mL of 0.5% ropivacaine produced consistent block success with a minimal HDP rate, suggesting the need for further studies to confirm this result in arthroscopic shoulder surgery.