Preserving the pulmonary vagus nerve branches during thoracoscopic esophagectomy
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Pulmonary vagus branches are transected as part of a transthoracic esophagectomy and lymphadenectomy for cancer. This may contribute to the development of postoperative pulmonary complications. Studies in which sparing of the pulmonary vagus nerve branches during thoracoscopic esophagectomy is investigated are lacking. Therefore, this study aimed to determine the feasibility and pitfalls of sparing pulmonary vagus nerve branches during thoracoscopic esophagectomy.
In 10 human cadavers, a thoracoscopic esophagectomy was performed while sparing the pulmonary vagus nerve branches. The number of intact nerve branches, their distribution over the lung lobes and the number and location of the remaining lymph nodes in the relevant esophageal lymph node stations (7, 10R and 10L) were recorded during microscopic dissection.
A median of 9 (range 5–16) right pulmonary vagus nerve branches were spared, of which 4 (0–12) coursed to the right middle/inferior lung lobe. On the left side, 10 (3–12) vagus nerve branches were spared, of which 4 (2–10) coursed to the inferior lobe. In 8 cases, lymph nodes were left behind, at stations 10R and 10L while sparing the vagus nerve branches. Lymph nodes at station 7 were always removed.
Sparing of pulmonary vagus nerve branches during thoracoscopic esophagectomy is feasible. Extra care should be given to the dissection of peribronchial lymph nodes, station 10R and 10L.
KeywordsThoracoscopic esophagectomy Pulmonary nerves Mediastinal lymphadenectomy Pulmonary complications
We thank Miangela Lacle, pathologist at the University Medical Center Utrecht, for her advice regarding which tissue microsections contained lymphoid tissue and which did not. We thank Simon Plomp and Fiona van Zoomeren of the Department of Anatomy of the University Medical Center Utrecht for their assistance with all the logistics regarding the cadavers. Suzanne Verlinde-Schellekens and Jan-Willem de Groot are acknowledged for performing the histology.
Compliance with ethical standards
Teus J Weijs, MD; Jelle P Ruurda, MD, PhD; Misha DP Luyer, MD, PhD; Grard AP Nieuwenhuijzen, MD, PhD; Sylvia van der Horst, Ronald LAW Bleys, MD, PhD; and Richard van Hillegersberg, MD, PhD have no conflicts of interest to declare.
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