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Prevention of intra-thoracic recurrent laryngeal nerve injury with robot-assisted esophagectomy

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Abstract

Purpose

Transthoracic esophagectomy for esophageal cancer is one of the most invasive procedures in surgery for gastrointestinal cancer. Serious complications sometimes occur after esophageal cancer surgery, including recurrent laryngeal nerve injury and pneumonia. The purpose of this study was to access the possibility of robot-assisted thoracoscopic esophagectomy for esophageal cancer in terms of preventing recurrent laryngeal nerve injury.

Methods

Operations in thoracic part were performed in prone position with bilateral ventilation. During dissection of the recurrent laryngeal nerve lymph nodes, thin blood vessels were coagulated with Maryland bipolar forceps in the left hand and then dissected with monopolar scissors in the right hand. Especially when dissecting left recurrent laryngeal nerve lymph nodes, the nerve was left unisolated from the vascular sheath that involves the aortic arch. Short-term outcomes including operative time, estimated blood loss, and postoperative complications including recurrent laryngeal nerve injury were accessed.

Results

From November 2018 to January 2020, 20 patients underwent robot-assisted thoracoscopic esophagectomy for esophageal cancer. Thoracic operative time was 242 min, estimated blood loss in the thoracic part was minimal, the number of dissected mediastinal lymph nodes was 19 (all median), and the incidence rates of recurrent laryngeal nerve injury and pneumonia were 10% (2 case) and 10% (2 cases), respectively.

Conclusion

Robot-assisted thoracoscopic esophagectomy for esophageal cancer has the possibility of reducing recurrent laryngeal nerve injury even in the introductory period. Randomized controlled trials are required to confirm this advantage of the robotic surgery.

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Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Kei Hosoda, Masahiro Niihara, Hideki Ushiku, Hiroki Harada, Mikiko Sakuraya, Marie Washio, Keishi Yamashita & Naoki Hiki

  2. Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan

    Keishi Yamashita

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  1. Kei Hosoda
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Contributions

Kei Hosoda, Keishi Yamashita, and Naoki Hiki participated in the study conception and design. Kei Hosoda, Masahiro Niihara, Hideki Ushiku, Hiroki Harada, Mikiko Sakuraya, and Marie Washio participated in acquisition of data. Analysis and interpretation of data were performed by Kei Hosoda, Keishi Yamashita, and Naoki Hiki. Kei Hosoda performed the drafting. Critical revision was done by Keishi Yamashita and Naoki Hiki

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Correspondence to Kei Hosoda.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Hosoda, K., Niihara, M., Ushiku, H. et al. Prevention of intra-thoracic recurrent laryngeal nerve injury with robot-assisted esophagectomy. Langenbecks Arch Surg 405, 533–540 (2020). https://doi.org/10.1007/s00423-020-01904-0

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