Recurrent laryngeal nerve monitoring during totally robot-assisted Ivor Lewis esophagectomy
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ORIGINAL ARTICLE
Recurrent laryngeal nerve monitoring during totally robot-assisted Ivor Lewis esophagectomy J. I. Staubitz 1 & P. C. van der Sluis 1 & F. Berlth 1 & F. Watzka 1 & F. Dette 2 & A. Läßig 3 & H. Lang 1 & T. J. Musholt 4 & P. P. Grimminger 1 Received: 6 July 2020 / Accepted: 10 September 2020 # The Author(s) 2020
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. Keywords Esophageal cancer . Larynx . Robot-assisted surgery . Intraoperative nerve monitoring
Introduction The use of intraoperative nerve monitoring (IONM) was shown to contribute to the identification of the recurrent * P. P. Grimminger [email protected] 1
Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
2
Department of Anesthesiology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
3
Communication Disorders Division, Department of Otorhinolaryngology, University Medical Center Mainz, Johannes Gutenberg University Mainz, 55131 Mainz, Germany
4
Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
laryngeal nerve (RLN) in different studies analyzing thyroidectomy, esophagectomy, and mediastinal lymph node dissection [1–3]. The reliable identification of the RLN is essential for an intentional preservation of the nerve during surgery. The DaVinci Xi robotic
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