Anomalies of the right vertebral vein increasing the difficulty of lymph-node dissection along the right recurrent laryngeal nerve: a single-institution, retrospective study

Esophagus ◽  
2020 ◽  
Vol 17 (3) ◽  
pp. 257-263
Author(s):  
Shoh Yajima ◽  
Takashi Fukuda ◽  
Daiji Oka ◽  
Keisuke Mishima ◽  
Misako Shibamoto ◽  
...  
Keyword(s):  
Lymph Node ◽  
Retrospective Study ◽  
Recurrent Laryngeal Nerve ◽  
Lymph Node Dissection ◽  
Laryngeal Nerve ◽  
Node Dissection ◽  
Single Institution ◽  
The Right

Lymph node dissection along the right recurrent laryngeal nerve (RLN)

ASVIDE ◽  
2016 ◽  
Vol 3 ◽  
pp. 450-450
Author(s):  
Hiroshi Makino ◽  
Hiroshi Yoshida ◽  
Hiroshi Maruyama ◽  
Tadashi Yokoyama ◽  
Atsushi Hirakata ◽  
...  
Keyword(s):  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Lymph Node Dissection ◽  
Laryngeal Nerve ◽  
Node Dissection ◽  
The Right

VS01.08: STEPWISE APPROACH FOR ROBOT-ASSISTED THORACOSCOPIC LEFT RECURRENT LARYNGEAL NERVE LYMPH NODE DISSECTION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 45-45
Author(s):  
Yin-Kai Chao
Keyword(s):  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Lymph Node Dissection ◽  
Dorsal Side ◽  
Laryngeal Nerve ◽  
Node Dissection ◽  
Robot Assisted ◽  
Stepwise Approach ◽  
Left Recurrent Laryngeal Nerve ◽  
The Right

Abstract Description This video showed the stepwise approach for robot-assisted thoracoscopic left recurrent laryngeal nerve lymph node dissection. With the patient lying in the left semiprone position, a total of five trocars were positioned. Left RLN LND was begun by releasing the right esophagotracheal band. Subsequently, the trachea was gradually rotated clockwise through the application of a gentle pressure on the left edge of the tracheal cartilage with the goal of exposing and releasing the left esophagotracheal band. After the complete release of the bilateral esophagotracheal band, the esophagus was retracted toward the dorsal side with the right first robotic arm. Simultaneously, an assistant rolled back the trachea using a forceps grasping a small piece of gauze, with the aim of improving operative exposure. The left RLN was identified in the middle of the soft tissue between the trachea and the esophagus. Dissection was started from the ventral side RLN nodes and subsequently continued toward the dorsal side until the total skeletonization of the left RLN Disclosure All authors have declared no conflicts of interest.

P179 THORACOSCOPIC EXTENDED 2-FIELD LYMPH NODE DISSECTION FOR ESOPHAGEAL CANCER. IMPLEMENTATION AND SURGICAL TECHNIQUE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Eleandros Kyros ◽  
Konstantinos Zografos ◽  
Ilias Vagios ◽  
Natasha Hasemaki ◽  
Lysandros Karydakis ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Surgical Technique ◽  
Lymph Nodes ◽  
Recurrent Laryngeal Nerve ◽  
Prone Position ◽  
Lymph Node Dissection ◽  
Laryngeal Nerve ◽  
Node Dissection ◽  
The Right

Abstract Aim Lymphadenectomy in minimally-invasive esophageal cancer surgery still remains challenging and standardization of surgical procedures is of extreme importance. The aim of this study is to present our safe and reproducible technique in thoracoscopic superior lymphadenectomy during esophagectomy for cancer. Background & Methods In esophageal cancer surgery, dissection of the superior mediastinal lymph-nodes is of high importance. For adequate mediastinal lymph-node dissection, an extensive operating field is required along with appropriate equipment and experience. Thoracoscopy in prone position provides excellent visualization of the operative field comparing to thoracotomic phase. A step-by-step explanation of our surgical technique during thoracoscopic superior lymphadenectomy is provided. Results All patients were placed in prone position. The entire posterior mediastinal pleura was incised; azygos arch was divided with clips, facilitating dissection of the left side of the posterior mediastinum. The descending thoracic aorta was freed anteriorly, separating the esophagus; the thoracic duct was dissected and divided with vascular clips. Esophageal hiatus was dissected circumferentially and the esophageal wall was freed from the pericardiumanteriorly. Subcarinal lymph-nodes were dissected en bloc. Upper thoracic esophagus was separated from the membranous part of the trachea. The right recurrent laryngeal nerve lymph nodes were dissected at the level of the right subclavian artery, with extreme caution to avoid nerveinjury. Left recurrent laryngeal nerve was identified by posterior traction of the esophagus using a full thickness transluminal suture;by pulling it through a separate skin incision, the relative lymph nodes were dissected. Conclusion It is interesting that, higher number of lymph-nodes are harvested with this procedure which may be the result of better visualization/access. Overall, our technique has been standardized, is safe and reproducible and could be adopted by specialized Upper GI Units.

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

2020 ◽  
Vol 405 (8) ◽  
pp. 1091-1099
Author(s):  
J. I. Staubitz ◽  
P. C. van der Sluis ◽  
F. Berlth ◽  
F. Watzka ◽  
F. Dette ◽  
...  
Keyword(s):  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Node Dissection ◽  
Robot Assisted ◽  
Nerve Monitoring ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Vocal Cord Paresis ◽  
The Right

Abstract 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.

VS01.06: THORACOSCOPIC EXTENDED LYMPHADENECTOMY FOR EGJ CANCER: AN OPTION TO LEARN FROM THE EAST

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 45-45
Author(s):  
Simone Giacopuzzi ◽  
Jacopo Weindelmayer ◽  
Giovanni De Manzoni
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Recurrent Laryngeal Nerve ◽  
Esophagogastric Junction ◽  
Conflicts Of Interest ◽  
Laryngeal Nerve ◽  
Extended Lymphadenectomy ◽  
Node Dissection ◽  
Node Metastasis ◽  
The Right

Abstract Description Extended thoracoscopic lymphadenectomy is not common practice in Western countries in patients with adenocarcinoma of the esophagogastric junction. In this video we present a case of a patient with siewert I adenocarcinoma with lymph node metastasis to the right recurrent laryngeal nerve not treated with neoadjuvant therapy, due to comorbidity. The operation was: extended thoracoscopic en-block lymph node dissection. video will be edited in a more rigorous manner Disclosure All authors have declared no conflicts of interest.

scholarly journals Recurrent laryngeal nerve injury in endoscopic surgery for thyroid cancer

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Hoàng Hiệp Phan ◽  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Neck Dissection ◽  
Lymph Node Dissection ◽  
Differentiated Thyroid Cancer ◽  
Endoscopic Thyroidectomy ◽  
Central Compartment ◽  
Laryngeal Nerve ◽  
Node Dissection

Tóm tắt Đặt vấn đề: Tổn thương dây thần kinh thanh quản quặt ngược (TQQN) là một biến chứng hay gặp trong phẫu thuật ung thư tuyến giáp. Phẫu thuật nội soi mới được ứng dụng và biến chứng này cũng là một lo ngại với các phẫu thuật viên. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang, theo dõi dọc. Người bệnh được chẩn đoán là ung thư tuyến giáp thể biệt hóa giai đoạn sớm, được điều trị phẫu thuật bằng mổ nội soi tại Bệnh viện Nội tiết trung ương từ tháng 01 năm 2013 đến tháng 9 năm 2016. Kết quả: 95 người bệnh (NB) được chẩn đoán là ung thư tuyến giáp thể biệt hóa giai đoạn sớm được phẫu thuật nội soi theo chỉ định. Tổn thương dây thần kinh TQQN không gặp khi cắt 1 thùy tuyến giáp. Tổn thương dây thần kinh TQQN tạm thời khi cắt toàn bộ tuyến giáp tổn thương là 4,8%, cắt toàn bộ tuyến giáp và nạo vét hạch 1 khoang, 2 khoang và 3 khoang lần lượt là 3,6%, 5,6% và 1/5, tính chung là 5,3%. Tổn thương dây thần kinh TQQN vĩnh viễn (sau mổ 6 tháng) có 1 người bệnh (1,1%), trường hợp này thường là có nhân nằm tại vị trí dây chằng Berry đi vào của dây thần kinh TQQN. Tổn thương dây thần kinh của nhóm nạo vét hạch khoang trung tâm (5,6%) cao hơn so với nạo vét hạch khoang bên (3,6%) sự khác biệt có ý nghĩa thống kê (p=0,015). Liệt dây thần kinh TQQN trong nhóm nạo vét hạch cổ tăng hơn gấp 1,27 lần ở nhóm không nạo vét hạch (p = 0,025). Kết luận: Tỉ lệ tổn thương dây thần kinh TQQN phụ thuộc vào phương pháp phẫu thuật tuyến giáp và có nạo vét hạch cổ hay không. Tỉ lệ này sẽ tăng khi nạo vét hạch, đặc biệt là nạo vét hạch khoang trung tâm. Abstract Background: Recurrent laryngeal nerve (RLN) injury is a common complication in thyroidectomy. Endoscopic thyroidectomy has just been applied for thyroid cancer and RLN injury is also a concern of the surgeons. Materials and Methods: It’s a cross-sectional with longitudinal study. Patients with early differentiated thyroid cancer were enrolled into this study underwent endoscopic thyroidectomy in National hospital of Endocrinology from January 2013 to September 2016. Results: 95 patients with early differentiated thyroid cancer underwent endoscopic thyroidectomy were included. No RLN injury occurred for one lobectomy. Transient RLN injury was 5,3% in total of which was 4,8% after total thyroidectomy (TT), TT with compartment neck dissection were 3,6%; 5,6% and 1/5, respectively. One patient with permanent RLN injury (1,1%) due to the node is located into Berry ligament of RLN. There was a significantly increased risk of RLN injury after TT with central compartment neck dissection compared to TT with lateral compartment neck dissection (5,6% vs 3,6%, p=0,015). RLN injury was significantly higher for TT with lymph node dissection is 1,27 than the group without lymph node dissection (p=0.025). Conclusions: RLN injury rate was significantly influenced by types of thyroidectomy and with/without lymph node dissection. The rate was increased after TT with lymph node dissection, especially central compartment neck dissection. Keywords: Early differentiated thyroid cancer, Endoscopic thyroidectomy.

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