PS02.017: EFFICACY OF INTRAOPERATIVE RECURRENT LARYNGEAL NERVE MONITORING DURING UPPER MEDIASTINAL LYMPH NODE DISSECTION IN THORACOSCOPIC RADICAL ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 125-125
Author(s):  
Shigeru Lee ◽  
Yushi Fujiwara ◽  
Ryoya Hashiba ◽  
Ken Gyobu ◽  
Daiki Inazu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Lymph Node Dissection ◽  
Tracheal Tube ◽  
Mediastinal Lymph Node ◽  
Laryngeal Nerve ◽  
Mediastinal Lymph Node Dissection ◽  
Node Dissection ◽  
Radical Esophagectomy ◽  
Nerve Monitoring

Abstract Background The development of minimally invasive surgery has yielded many benefits, therefore the number of patients undergoing thoracoscopic radical esophagectomy (TRE) for esophageal cancer has been increasing worldwide. However, in the Japanese nationwide web-based database report, the incidence of recurrent laryngeal nerve (RLN) paralysis and overall morbidity were significantly higher in the TRE group than in the open esophagectomy group. In recent years, intraoperative nerve monitoring (IONM) is commonly being used in thyroid and parathyroid surgery in many centers. We tried to determine the feasibility and effectiveness of IONM of RLN during upper mediastinal lymph node dissection in TRE. Methods All 628 patients who underwent TRE in the left lateral decubitus position at Osaka City University Hospital between May 1995 and February 2018 were enrolled in the present study. We introduced IONM using NIM® (Medtronic) during TRE from October 2016 at our hospital. We divided retrospectively the patients into two groups: IONM group (TRE with IONM of RLN; n = 49) and No-IONM group (TRE without IONM of RLN; n = 579). Diagnosis of RLN paralysis was performed using laryngoscopy. The feasibility of IONM during TRE and the incidence of postoperative RLN paralysis were compared with those in No-IONM group. Results IONM could be performed for 46 patients (93.9%) in IONM group. Three patients (6.1%) could not keep single-lung ventilation using a single lumen tracheal tube with a bronchial blocker and needed to replace a tracheal tube by a double lumen tube during TRE. The incidence of postoperative RLN paralysis (CD≧ 1; CD; Clavien-Dindo classification of surgical complications) was 17.4% in IONM group and 30.2% in No- IONM group. There was a significant difference in the incidence of postoperative RLN paralysis (P < 0.05). Moreover, the right and bilateral paralysis of RLN after TRE did not occur in any patients in IONM group. Conclusion IONM of RLN during TRE is technically feasible. The introduction of standardized IONM of RLN during TRE is able to reduce the incidence of postoperative RLN paralysis. Disclosure All authors have declared no conflicts of interest.

scholarly journals Chylothorax and Recurrent Laryngeal Nerve Injury Associated with Robotic Video-Assisted Mediastinal Lymph Node Dissection

2015 ◽  
Vol 10 (3) ◽  
pp. 170-173 ◽  
Author(s):  
Inderpal S. Sarkaria ◽  
David J. Finley ◽  
Manjit S. Bains ◽  
Prasad S. Adusumilli ◽  
Nabil P. Rizk ◽  
...  
Keyword(s):  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Lymph Node Dissection ◽  
Mediastinal Lymph Node ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Node Dissection ◽  
Laryngeal Nerve Injury ◽  
Lung Resections

Objective Although the technical aspects of robotic video-assisted thoracic surgery (RVATS) for lung resections may be advantageous, compared with standard thoracoscopy, complications of chylothorax and recurrent laryngeal nerve injury (RLNI) associated with mediastinal lymph node dissection (MLND) may be significant. Methods Consecutive patients who underwent RVATS anatomic lung resection for suspected or confirmed cancer and experienced RLNI or chylothorax were identified and reviewed from a prospectively maintained database. Complications were graded according to the Common Terminology Criteria for Adverse Events version 3.0. Results From July 28, 2010, to December 20, 2013, 251 patients underwent RVATS segmentectomy, lobectomy, or bilobectomy with MLND. Eleven patients (4.4%) experienced MLND-related complications and composed the study group; 81.8% were right-sided resections, and the median lymph node counts in right station IV and station VII were 9 (range, 1–23) and 5.5 (range, 1–10); 72.7% of the cases were performed for early-stage I and II lung cancers. Chylothorax [6/251 (2.4%)] and RLNI [6/251 (2.4%)] were significantly more common in the RVATS group than in the open thoracotomy and standard VATS groups. Complications requiring procedural intervention (Grade 3) are as follows: 4 cases of RLNI in patients undergoing percutaneous vocal cord medialization and 3 cases of chylothorax in patients undergoing image-guided thoracic duct embolization or maceration. No operative interventions were required. Conclusions RVATS MLND may be associated with increased rates of chylothorax and RLNI. Attention must be paid to identifying potential technical pitfalls with RVATS lung resections, adjusting surgical techniques accordingly, and minimizing patient morbidity.

P223 BILATERAL RECURRENT LARYNGEAL NERVE LYMPHADENECTOMY DURING THORACOSCOPIC ESOPHAGECTOMY IN PRONE POSITION

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R Jiménez-Rosellón ◽  
F Mingol ◽  
A Navío ◽  
M Bruna ◽  
E Álvarez ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Minimally Invasive ◽  
Lymph Nodes ◽  
Recurrent Laryngeal Nerve ◽  
Prone Position ◽  
Lymph Node Dissection ◽  
Mediastinal Lymph Node ◽  
Laryngeal Nerve ◽  
Node Dissection

Abstract Aim To present a video of a complete bilateral recurrent laryngeal nerve lymphadenectomy performed during minimally invasive esophagectomy using thoracoscopic video-assisted surgery in the prone position. Background and Methods Surgical treatment for esophageal cancer needs detailed lymphadenectomy. Indeed, the number of surgically dissected lymph nodes is important for staging accuracy and also determines patient’s prognosis, including those along the recurrent laryngeal nerve. However, recurrent laryngeal nerve dissection remains difficult and increases the appearance of postoperative complications. This is a video of a bilateral recurrent laryngeal nerve lymphadenectomy during thoracoscopic esophagectomy performed in the prone position in a female patient with esophageal cancer. Results A 75 year-old female was diagnosed with recurrent squamous cell middle third esophageal carcinoma. The patient had first been diagnosed eleven years ago, receiving chemoradiotherapy as a radical treatment. The patient achieved a complete response after treatment, which remained for eleven years. Eleven years later, during routine follow-up, tumor recurrence was identified in the middle third of the esophagus. After presentation in a Multidisciplinary Group the patient underwent minimally invasive McKeown esophagectomy. First, a video-assisted thoracoscopic surgery was performed in the prone position to mobilize the thoracic esophagus and complete a detailed mediastinal lymph node dissection, including infra-carinal lymph nodes, bilateral bronchial lymph nodes and also bilateral recurrent laryngeal nerve lymph nodes. Afterwards, the abdominal esophagus and lymph node dissection is performed using a laparoscopic approach, and also a left cervicotomy in the supine position. An assistance laparotomy was made to externalize the specimen and make the gastric conduit. A manual end-to end esophago-gastric anastomosis was executed and finally, a feeding jejunostomy tube was placed. The patient presented a benign postoperative course, introducing enteral nutrition and oral intake developing no complications, such as dysphonia, nor dysphagia and was discharged on the 8th postoperative day. The postoperative barium swallow radiography showed no leaks nor other complications and pathology report confirmed tumor free resection margins. Conclusion Detailed mediastinal lymph node dissection and exhaustive bilateral recurrent laryngeal nerve lymphadenectomy can be safely performed by minimally invasive surgery, as is shown in the video. The technique shown is feasible, achieves a complete lymph-node dissection and avoids postoperative complications such as dysphonia and recurrent laryngeal nerve palsy.

152 SURGICAL PROCEDURE AND OUTCOME OF MEDIASTINOSCOPIC RADICAL ESOPHAGECTOMY FOR ESOPHAGOGASTRIC JUNCTION CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Atsushi Shiozaki ◽  
Hitoshi Fujiwara ◽  
Hirotaka Konishi ◽  
Michihiro Kudou ◽  
Hiroki Shimizu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Single Port ◽  
Mediastinal Lymph Node ◽  
Mediastinal Lymph Node Dissection ◽  
Node Dissection ◽  
En Bloc ◽  
Radical Esophagectomy ◽  
Postoperative Respiratory Complications ◽  
Cervical Approach

Abstract   We started performing mediastinal lymph node dissection by a laparoscopic transhiatal approach (LTHA) in 2009. To date, 371 patients had undergone our method during various esophageal surgical procedures, including esophagogastric junction cancer (EGJC). Furthermore, we started performing single-port mediastinoscopic cervical approach in 2014, and developed a simple technique for transmediastinal radical esophagectomy (TMr) without thoracic approach (258 cases). Forty patients with EGJC were also treated by TMr. Methods Left single-port mediastinoscopic cervical approach was performed with pneumomediastinum. Mainly for advanced SCC, upper mediastinal lymph node dissection including recurrent laryngeal nerve LNs was performed with intraoperative monitoring using NIM system. Next, LTHA was performed for en bloc mediastinal lymph node dissection. The esophageal hiatus was opened, and working space was secured by Long Retractors. The posterior plane of the pericardium was extended. The posterior side of LNs was then separated. Finally, while lifting LNs like a membrane, they were resected from bilateral mediastinal pleura. Reconstruction with narrow gastric conduit was performed through substernal tract. Results Patients with EGJC performed TMr were analyzed (n = 40, SCC/Adeno/Others = 21/17/2). Upper mediastinal lymph node metastasis was found in 6 cases (SCC/Adeno = 3/3), middle mediastinal lymph node metastasis was found in 2 cases (SCC/Adeno = 1/1), and all of them had advanced tumors. Their perioperative outcome were compared with those performed the right thoracotomy (n = 41). The operative time and bleeding were decreased by TMr. The number of resected mediastinal lymph nodes, pR0 rate, and mediastinal recurrence in the two groups were not different. In 95.0% of patients treated by TMr, extubation was performed at 0 POD. Postoperative respiratory complications was decreased by TMr (TMr:7.5%, thoracotomy:17.1%). Conclusion This procedure, TMr, resulted in a good surgical view, safe en-bloc mediastinal lymph node dissection, and the decrease of postoperative respiratory complications in patients with EGJC.

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