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01-06-2020 | Nerve Injury | How-I-Do-It articles

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

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

Published in: Langenbeck's Archives of Surgery | Issue 4/2020

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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Title: Prevention of intra-thoracic recurrent laryngeal nerve injury with robot-assisted esophagectomy
Authors: Kei Hosoda
Masahiro Niihara
Hideki Ushiku
Hiroki Harada
Mikiko Sakuraya
Marie Washio
Keishi Yamashita
Naoki Hiki
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Nerve Injury
Esophageal Cancer
Esophagus Resection
Esophageal Cancer
Lymphadenectomy
Esophagus Resection
Published in: Langenbeck's Archives of Surgery / Issue 4/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-01904-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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