Authors:	Staubitz, Julia Sluis, P. C. van der Berlth, F. Watzka, F. Dette, F. Läßig, A. Lang, H. Musholt, T. J. Grimminger, Peter P.
Title:	Recurrent laryngeal nerve monitoring during totally robot-assisted Ivor Lewis esophagectomy
Online publication date:	3-May-2021
Year of first publication:	2020
Language:	english
Abstract:	PURPOSE The robot-assisted approach for Ivor Lewis esophagectomy offers an enlarged, three-dimensional overview of the intraoperative situs. The vagal nerve (VN) can easily be detected, preserved, and intentionally resected below the separation point of the recurrent laryngeal nerve (RLN). However, postoperative vocal cord paresis can result from vagal or RLN injury during radical lymph node dissection, presenting a challenge to the operating surgeon. METHODS From May to August 2019, 10 cases of robot-assisted minimally invasive esophagectomy (RAMIE) with extended 2-field lymphadenectomy, performed at the University Medical Center Mainz, were included in a prospective cohort study. Bilateral intermittent intraoperative nerve monitoring (IONM) of the RLN and VN was performed, including pre- and postoperative laryngoscopy assessment. RESULTS Reliable mean signals of the right VN (2.57 mV/4.50 ms) and the RLN (left 1.24 mV/3.71 ms, right 0.85 mV/3.56 ms) were obtained. IONM facilitated the identification of the exact height of separation of the right RLN from the VN. There were no cases of permanent postoperative vocal paresis. Median lymph node count from the paratracheal stations was 5 lymph nodes. CONCLUSION IONM was feasible during RAMIE. The intraoperative identification of the RLN location contributed to the accuracy of lymph node dissection of the paratracheal lymph node stations. RLN damage and subsequent postoperative vocal cord paresis can potentially be prevented by IONM.
DDC:	610 Medizin 610 Medical sciences
Institution:	Johannes Gutenberg-Universität Mainz
Department:	FB 04 Medizin
Place:	Mainz
ROR:	https://ror.org/023b0x485
DOI:	http://doi.org/10.25358/openscience-5822
Version:	Published version
Publication type:	Zeitschriftenaufsatz
License:	CC BY
Information on rights of use:	https://creativecommons.org/licenses/by/4.0/
Journal:	Langenbeck's archives of surgery 405
Pages or article number:	1091 1099
Publisher:	Springer
Publisher place:	Berlin u.a.
Issue date:	2020
ISSN:	1435-2451
Publisher URL:	https://doi.org/10.1007/s00423-020-01990-0
Publisher DOI:	10.1007/s00423-020-01990-0
Appears in collections:	JGU-Publikationen