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Palsy of the recurrent laryngeal nerves in association with an ultrasonic activated device during thoracoscopic esophagectomy with three-field lymphadenectomy

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Abstract

Background

Ultrasonic activated devices (USADs) may produce inadvertent injuries due to heat or shock waves. However, thermal injury and shock waves are considered to be avoidable if these devices are used appropriately.

Methods

Utilizing a porcine model, we examined the relationship between the occurrence of tissue damage around the iliac artery and sciatic nerve and the usage of an USAD. Thereafter, we prospectively determined the clinical outcomes following the usage of the USAD during dissection along the recurrent laryngeal nerves (RLN) in 114 consecutive patients who underwent thoracoscopic esophageal surgery.

Results

The temperatures measured in the pig iliac artery and sciatic nerve more than 2 mm from the activating blade (at a power setting of 70 %, within 2 s) did not increase to 42 °C. In a subsequent clinical series using the short activating technique according to the findings of in vivo experiments, scheduled laryngoscopic studies showed the rate of vocal cord palsy after esophagectomy to be 39 %, which was more sensitive than the substantial presence of hoarseness (28 %).

Conclusions

Adverse effects by using the USAD on the nerves may be avoidable if the activation of the current using an USAD is conducted within 2 s at positions more than 2 mm from the nerves. This short activation technique using the USAD is therefore considered to be safe and feasible for lymph node dissection along the RLNs during thoracoscopic esophagectomy, although the apparent reasons for postoperative dysfunction in the vocal cords remain unclear.

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Author information

Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan

    Hirokazu Noshiro, Yukie Yoda & Hiroshi Kono

  2. Department of Pathology, Saga University Hospital, Saga, Japan

    Keita Kai

  3. Department of Surgery, Japan Community Health Care Organization Kyushu Hospital, Kitakyushu, Japan

    Akihiko Uchiyama

Authors
  1. Hirokazu Noshiro
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  2. Keita Kai
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  3. Yukie Yoda
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  4. Hiroshi Kono
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  5. Akihiko Uchiyama
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Corresponding author

Correspondence to Hirokazu Noshiro.

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Ethical Statement

This study conforms to the guidelines set forth in the Declaration of Helsinki revised in 2000. We have protected the privacy of the patient, and the manuscript does not include any identifying information. All institutional and national guidelines for the care and use of laboratory animals were followed. This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of interest

Drs. Hirokazu Noshiro, Keita Kai, Yukie Yoda, Hiroshi Kono, and Akihiko Uchiyama have no conflicts of interest or financial ties to disclosure.

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Noshiro, H., Kai, K., Yoda, Y. et al. Palsy of the recurrent laryngeal nerves in association with an ultrasonic activated device during thoracoscopic esophagectomy with three-field lymphadenectomy. Esophagus 13, 351–360 (2016). https://doi.org/10.1007/s10388-016-0543-7

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  • DOI: https://doi.org/10.1007/s10388-016-0543-7

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