SSAT - CONTINUOUS INTRAOPERATIVE VAGUS NERVE STIMULATION FOR MONITORING OF RECURRENT LARYNGEAL NERVE FUNCTION DURING LYMPHADENECTOMY IN MINIMALLY INVASIVE ESOPHAGECTOMY

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CONTINUOUS INTRAOPERATIVE VAGUS NERVE STIMULATION FOR MONITORING OF RECURRENT LARYNGEAL NERVE FUNCTION DURING LYMPHADENECTOMY IN MINIMALLY INVASIVE ESOPHAGECTOMY
Ian Yu Hong Wong^*, Raymond King Yin Tsang, Daniel King Hung Tong, Siu Y. Chan, Kwan Kit Chan, Claudia Wong, Tsz Ting Law, Simon Law
Surgery, The University of Hong Kong, Hong Kong, Hong Kong

Introduction: For squamous cell cancer of the esophagus, extended mediastinal lymphadenectomy especially of the bilateral recurrent laryngeal nerves (RLN) is associated with high risk of nerve injury. Methods to improve safety of lymphadenectomy are desirable. Continuous intraoperative nerve monitoring (CIONM) based on a system using vagus nerve stimulation was tested.
Methods: From May 2014 to December 2015, 40 patients who underwent thoracoscopic esophagectomy were recruited. Intermittent nerve stimulation for mapping and CIONM were employed to monitor the left RLN dissection, while only intermittent stimulation was used for right RLN lymphadenectomy. Surgical outcome was documented, especially with regards to RLN palsy rates.
Results: Technical problems precluded successful use of CIONM in 6 patients. Overall 10 patients developed RLN palsies (one of whom was bilateral), nerve palsy rate was therefore 25%. Right RLN palsy occurred in 2 patients (5%). For the left side, 9 patients had palsies (22.5%). Left RLN dissection was performed in 27 patients in total, out of them 7 had injury (25.9%). In two patients who had left RLN palsies, left RLN lymphadenectomy was not performed; the injury was related to traction. There was no hospital death. On follow-up, 4 out of the 10 patients who had nerve palsies have recovered, at 5, 6, 6 and 9 weeks postoperatively, prolonged nerve palsy rate was therefore 15%. All had left RLN injuries except the one patient who had bilateral nerve palsies, in whom the right RLN recovered.
Conclusions: RLN palsy rate was comparable with series with extended RLN lymphadenectomy. CIONM has potential to aid RLN dissection. More patients are required to improve on the technical aspects of the method as well as technique of RLN dissection.

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