scholarly journals Review of different approaches of the left recurrent laryngeal nerve area for lymphadenectomy during minimally invasive esophagectomy

2019 ◽  
Vol 11 (S5) ◽  
pp. S766-S770 ◽  
Author(s):  
Miguel A. Cuesta
Keyword(s):  
Minimally Invasive ◽  
Recurrent Laryngeal Nerve ◽  
Minimally Invasive Esophagectomy ◽  
Laryngeal Nerve ◽  
Invasive Esophagectomy ◽  
Left Recurrent Laryngeal Nerve

270 LYMPHADENECTOMY ALONG BILATERAL RECURRENT LARYNGEAL NERVE UNDER SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
X Wu ◽  
X Gan ◽  
Q Cao
Keyword(s):  
Minimally Invasive ◽  
Recurrent Laryngeal Nerve ◽  
Minimally Invasive Esophagectomy ◽  
Cell Cancer ◽  
Laryngeal Nerve ◽  
Lower Edge ◽  
Invasive Esophagectomy ◽  
Surgical Methods ◽  
Left Neck ◽  
The Right

Abstract   Mediastinal lymphadenectomy is a crucial part of minimally invasive esophagectomy, and requires transthoracic operation, which is a crucial independent risk factor for the incidence of pulmonary complications. Conventionally, non-transthoracic esophagectomy was often achieved by mediastinoscope-assisted laparoscopic transhiatal surgery. Because of the small space, the lymphadenectomy could be only performed partially under mediastinoscope in upper mediastinal. We propose a new approach of lymphadenectomy along bilateral recurrent laryngeal nerve under mediastinoscopy through one left-neck incision. Methods A 3-cm incision paralleling the clavicle was made at 2-cm from the supraclavicular region in the left neck. After established pneumomediastinum (10-12 mmHg carbon dioxide), esophagectomy begins to perform over the aortic arch to the level of lower edge of the left main bronchus, and the lymphadenectomy along the left RLN has also accomplished during this process. At the level of lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, the instruments could get accessed to the right RLN. The lymphadenectomy could get accomplished up to 2-cm at the upper edge of the RSA. Results The mean age of 56 esophageal squamous cell cancer patients was 67.4 years, 46 males and 10 females. Tumor location: middle thoracic, 31 patients, lower thoracic, 23 patients. Preoperative TNM staging: T1b was 10 cases, T2 was 35 cases, and T3 was 11 cases. The median number of mediastinal LNs removed was 17 (9 to 23); 6 (2 to 9) along the left RLN; 3 (1 to 6) along the right RLN. 7 patients (12.5%) developed RLN palsy. Postoperative laryngoscopy showed that all of the 7 RLN palsy were left side, none of them appeared at 3 months postoperation. Conclusion This approach enables the lymphadenectomy along bilateral RLN through one left neck incision. During the operation, the upper mediastinal LNs along the bilateral RLN were clearly revealed and en bloc excised. Meanwhile, the bilateral RLN were fully exposed and protected during the procedure. Compared with the previous surgical methods,this procedure is less invasive, and the bilateral RLN could be exposed much clearer. It would provide a novel approach for the minimally invasive esophagectomy, especially lymphadenectomy.

scholarly journals Learning Curve for Lymph Node Dissection Around the Recurrent Laryngeal Nerve in McKeown Minimally Invasive Esophagectomy

2021 ◽  
Vol 11 ◽  
Author(s):  
Zi-Yi Zhu ◽  
Rao-Jun Luo ◽  
Zheng-Fu He ◽  
Yong Xu ◽  
Shao-Hua Xu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Recurrent Laryngeal Nerve ◽  
Minimally Invasive Esophagectomy ◽  
Laryngeal Nerve ◽  
Stable Phase ◽  
Invasive Esophagectomy ◽  
Study Results ◽  
The Impact

BackgroundCompared to open esophagectomy (OE), minimally invasive esophagectomy (MIE) is associated with lower morbidity and mortality. However, lymph node (LN) dissection around the recurrent laryngeal nerve (RLN) is still an important factor that affects the length of the learning curve of MIE. This study aims to evaluate the surgical outcomes of the first nearly 5-year period and explore the learning curve for LN dissection around the RLN in McKeown MIE by a new single surgical team.MethodsA total of 285 consecutive patients who underwent McKeown MIE between March 2016 and September 2020 were included at our institution. According to the cumulative sum (CUSUM) analysis of LN dissection around the RLN, the patients were divided into three groups: exploration period, adjustment period, and stable period. We assessed the impact of surgical proficiency on postoperative outcomes and explored the learning curve for LN dissection around the RLN in McKeown MIE.ResultsThe CUSUM graph showed that a point of upward inflection for LN dissection around the RLN was observed in 151 cases. After 151 cases, LNs around the right and left RLNs were dissected thoroughly compared to the exploration and adjustment period (P = 0.010 and P = 0.012, respectively), and the postoperative incidence of hoarseness significantly decreased from 11.1 to 1.5% (P<0.001).ConclusionsOur study results revealed that not only are the LN, around the RLN, sufficiently dissected but also the incidence of hoarseness significantly decreased in the stable phase. Consequently, the learning curve length was approximately 151 cases for LN dissection around the RLN in McKeown MIE.

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