Authors: Makoto Hikage Takashi Kamei Toru Nakano Shigeo Abe Kazunori Katsura Yusuke Taniyama Tadashi Sakurai Jin Teshima Soichi Ito Nobuchika Niizuma Hiroshi Okamoto Toshiaki Fukutomi Masato Yamada Shota Maruyama Noriaki Ohuchi
Publish Date: 2016/11/08
Volume: 31, Issue: 7, Pages: 2986-2996
Abstract
The problem of recurrent laryngeal nerve RLN paralysis RLNP after radical esophagectomy remains unresolved Several studies have confirmed that intraoperative nerve monitoring IONM of the RLN during thyroid surgery substantially decreases the incidence of RLN damage This study tried to determine the feasibility and effectiveness of IONM of the RLN during thoracoscopic esophagectomy in the prone position for esophageal cancerAll 108 patients who underwent prone esophagectomy at Tohoku University Hospital between July 2012 and March 2015 were included in this study We divided patients into two groups a control group NoMonitoring group surgery without IONM n = 54 and a study group Monitoring group surgery with IONM n = 54 In Monitoring group neural stimulation was performed for both RLNs before and after dissection in the thoracic procedure then for RLNs and vagus nerves VNs in the cervical procedure The feasibility of IONM in Monitoring group and early surgical outcomes were retrospectively compared with those in NoMonitoring groupIONM could be performed for 47 cases 870 in Monitoring group Reasons for discontinuation were use of muscle relaxants 3 patients change in thoracotomy procedure 2 patients past rib bone fracture 1 patient and allergic shock by transfusion 1 patient Right RLNPs were identified postoperatively in 4 patients and left RLNPs in 23 patients IONM sensitivities were 927 and 880 for the right and left VNs respectively Incidences of postoperative RLNP aspiration and primary pneumonia did not differ significantly between groupsWe thank T Nakagawa K Takaya C Sato and K Kamiya for helpful discussion Prof M Yamauchi for technical guidance and M Tokunaga for help with paper organization This work was supported by GrantsinAid for Scientific Research in Priority Areas from the Japan MEXT T Nakano and N OhuchiDrs Makoto Hikage Takashi Kamei Toru Nakano Shigeo Abe Kazunori Katsura Yusuke Taniyama Tadashi Sakurai Jin Teshima Soichi Ito Nobuchika Niizuma Hiroshi Okamoto Toshiaki Fukutomi Masato Yamada Shota Maruyama and Noriaki Ohuchi have no conflicts of interest or financial ties to disclose
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