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Intraoperative neuromonitoring during prone thoracoscopic esophagectomy for esophageal cancer reduces the incidence of recurrent laryngeal nerve palsy: a single-center study

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Abstract

The incidence of recurrent laryngeal nerve palsy (RLNP) following minimally invasive esophagectomy has yet to be satisfactorily reduced. Use of intraoperative neuromonitoring (IONM), specifically of the RLN, during thyroidectomy has been reported to reduce the incidence of RLN injury. We now apply IONM during curative prone thoracoscopic esophagectomy, and we conducted a retrospective study to evaluate the feasibility and efficacy of intermittent monitoring of the RLN during the surgery. The study involved 32 consecutive patients who underwent esophagectomy with radical lymph node dissection for esophageal cancer. The patients were of two groups: an IONM group (n = 17) and a non-IONM group (n = 15). We chiefly strip around the esophagus preserving the membranous structure, which contains the tracheoesophageal artery, lymph nodes, and RLN. In the IONM group patients, we stimulated the RLN and measured the electromyography (EMG) amplitude after dissection, at the dissection starting point and dissection end point on both sides. For the purpose of the study, we compared outcomes between the two groups of patients. IONM was carried out successfully in all 17 patients in the IONM group. The incidence of RLNP was significantly reduced in this group. We found that both RLNs can be identified by mean of IONM easily, immediately, and safely and that the EMG amplitude attenuation rate is particularly useful for predicting RLNP.

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Authors and Affiliations

  1. Department of Surgery, Teikyo University Hospital, Mizonokuchi, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, 213-8507, Japan

    Daisuke Fujimoto, Keizo Taniguchi & Hirotoshi Kobayashi

Authors
  1. Daisuke Fujimoto
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  2. Keizo Taniguchi
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  3. Hirotoshi Kobayashi
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Contributions

DF and KT were responsible for the study design and for the acquisition, analysis, and interpretation of the data. HK critically revised the manuscript.

Corresponding author

Correspondence to Daisuke Fujimoto.

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Conflict of interest

Daisuke Fujimoto, Keizo Taniguchi, and Hirotoshi Kobayashi have no conflict of interest or financial ties to disclose.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Ethics approval was obtained from the institutional review board of Teikyo University (No. 19-1312).

Research involving human participants and/or animals

Not applicable.

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Informed consent was obtained prior to recruitment from all individual participants included in this study.

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The datasets generated and/or analyzed during the current study are not publicly available because the data are confidential patient data but are available from the corresponding author on reasonable request.

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Supplementary file1 Video of lymphadenectomy along the left RLN (MP4 80701 KB)

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Fujimoto, D., Taniguchi, K. & Kobayashi, H. Intraoperative neuromonitoring during prone thoracoscopic esophagectomy for esophageal cancer reduces the incidence of recurrent laryngeal nerve palsy: a single-center study. Updates Surg 73, 587–595 (2021). https://doi.org/10.1007/s13304-020-00967-4

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  • DOI: https://doi.org/10.1007/s13304-020-00967-4

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