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Intraoperative Nerve Monitoring during Minimally Invasive Esophagectomy and 3-Field Lymphadenectomy: Safety, Efficacy, and Feasibility

BACKGROUND: The objective of this study was to demonstrate the safety, efficacy, and feasibility of intraoperative monitoring of the recurrent laryngeal nerves during thoracoscopic and robotic 3-field esophagectomy. METHODS: This retrospective analysis details our initial experience using intraopera...

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Autores principales: Gopinath, Srinivas Kodaganur, Jiwnani, Sabita, Valiyuthan, Parthiban, Parab, Swapnil, Niyogi, Devayani, Tiwari, Virendrakumar, Pramesh, C. S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society for Thoracic and Cardiovascular Surgery 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10480398/
https://www.ncbi.nlm.nih.gov/pubmed/37574880
http://dx.doi.org/10.5090/jcs.23.052
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author Gopinath, Srinivas Kodaganur
Jiwnani, Sabita
Valiyuthan, Parthiban
Parab, Swapnil
Niyogi, Devayani
Tiwari, Virendrakumar
Pramesh, C. S.
author_facet Gopinath, Srinivas Kodaganur
Jiwnani, Sabita
Valiyuthan, Parthiban
Parab, Swapnil
Niyogi, Devayani
Tiwari, Virendrakumar
Pramesh, C. S.
author_sort Gopinath, Srinivas Kodaganur
collection PubMed
description BACKGROUND: The objective of this study was to demonstrate the safety, efficacy, and feasibility of intraoperative monitoring of the recurrent laryngeal nerves during thoracoscopic and robotic 3-field esophagectomy. METHODS: This retrospective analysis details our initial experience using intraoperative nerve monitoring (IONM) during minimally invasive 3-field esophagectomy. Data were obtained from a prospectively maintained database and electronic medical records. The study included all patients who underwent minimally invasive (video-assisted thoracic surgery/robotic) transthoracic esophagectomy with neck anastomosis. The patients were divided into those who underwent IONM during the study period and a historical cohort who underwent 3-field esophagectomy without IONM at the same institution. Appropriate statistical tests were used to compare the 2 groups. RESULTS: Twenty-four patients underwent nerve monitoring during minimally invasive 3-field esophagectomy. Of these, 15 patients underwent thoraco-laparoscopic operation, while 9 received a robot-assisted procedure. In the immediate postoperative period, 8 of 24 patients (33.3%) experienced vocal cord paralysis. Relative to a historical cohort from the same institution, who were treated with surgery without nerve monitoring in the preceding 5 years, a 26% reduction was observed in the nerve paralysis rate (p=0.08). On follow-up, 6 of the 8 patients with vocal cord paralysis reported a return to normal vocal function. Additionally, patients who underwent IONM exhibited a higher nodal yield and a decreased frequency of tracheostomy and bronchoscopy. CONCLUSION: The use of IONM during minimally invasive 3-field esophagectomy is safe and feasible. This technique has the potential to decrease the incidence of recurrent nerve palsy and increase nodal yield.
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spelling pubmed-104803982023-09-07 Intraoperative Nerve Monitoring during Minimally Invasive Esophagectomy and 3-Field Lymphadenectomy: Safety, Efficacy, and Feasibility Gopinath, Srinivas Kodaganur Jiwnani, Sabita Valiyuthan, Parthiban Parab, Swapnil Niyogi, Devayani Tiwari, Virendrakumar Pramesh, C. S. J Chest Surg Clinical Research BACKGROUND: The objective of this study was to demonstrate the safety, efficacy, and feasibility of intraoperative monitoring of the recurrent laryngeal nerves during thoracoscopic and robotic 3-field esophagectomy. METHODS: This retrospective analysis details our initial experience using intraoperative nerve monitoring (IONM) during minimally invasive 3-field esophagectomy. Data were obtained from a prospectively maintained database and electronic medical records. The study included all patients who underwent minimally invasive (video-assisted thoracic surgery/robotic) transthoracic esophagectomy with neck anastomosis. The patients were divided into those who underwent IONM during the study period and a historical cohort who underwent 3-field esophagectomy without IONM at the same institution. Appropriate statistical tests were used to compare the 2 groups. RESULTS: Twenty-four patients underwent nerve monitoring during minimally invasive 3-field esophagectomy. Of these, 15 patients underwent thoraco-laparoscopic operation, while 9 received a robot-assisted procedure. In the immediate postoperative period, 8 of 24 patients (33.3%) experienced vocal cord paralysis. Relative to a historical cohort from the same institution, who were treated with surgery without nerve monitoring in the preceding 5 years, a 26% reduction was observed in the nerve paralysis rate (p=0.08). On follow-up, 6 of the 8 patients with vocal cord paralysis reported a return to normal vocal function. Additionally, patients who underwent IONM exhibited a higher nodal yield and a decreased frequency of tracheostomy and bronchoscopy. CONCLUSION: The use of IONM during minimally invasive 3-field esophagectomy is safe and feasible. This technique has the potential to decrease the incidence of recurrent nerve palsy and increase nodal yield. The Korean Society for Thoracic and Cardiovascular Surgery 2023-09-05 2023-08-14 /pmc/articles/PMC10480398/ /pubmed/37574880 http://dx.doi.org/10.5090/jcs.23.052 Text en Copyright © 2023, The Korean Society for Thoracic and Cardiovascular Surgery https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Research
Gopinath, Srinivas Kodaganur
Jiwnani, Sabita
Valiyuthan, Parthiban
Parab, Swapnil
Niyogi, Devayani
Tiwari, Virendrakumar
Pramesh, C. S.
Intraoperative Nerve Monitoring during Minimally Invasive Esophagectomy and 3-Field Lymphadenectomy: Safety, Efficacy, and Feasibility
title Intraoperative Nerve Monitoring during Minimally Invasive Esophagectomy and 3-Field Lymphadenectomy: Safety, Efficacy, and Feasibility
title_full Intraoperative Nerve Monitoring during Minimally Invasive Esophagectomy and 3-Field Lymphadenectomy: Safety, Efficacy, and Feasibility
title_fullStr Intraoperative Nerve Monitoring during Minimally Invasive Esophagectomy and 3-Field Lymphadenectomy: Safety, Efficacy, and Feasibility
title_full_unstemmed Intraoperative Nerve Monitoring during Minimally Invasive Esophagectomy and 3-Field Lymphadenectomy: Safety, Efficacy, and Feasibility
title_short Intraoperative Nerve Monitoring during Minimally Invasive Esophagectomy and 3-Field Lymphadenectomy: Safety, Efficacy, and Feasibility
title_sort intraoperative nerve monitoring during minimally invasive esophagectomy and 3-field lymphadenectomy: safety, efficacy, and feasibility
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10480398/
https://www.ncbi.nlm.nih.gov/pubmed/37574880
http://dx.doi.org/10.5090/jcs.23.052
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