Anatomical basis of the risk of injury to the right laryngeal recurrent nerve during thoracic surgery

Benouaich, Vincent; Porterie, Jean; Bouali, O.; Moscovici, J.; Lopez, R.

doi:10.1007/s00276-012-0946-7

Cited by 13 publications

(7 citation statements)

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“…Intraoperative removal of the paratracheal and upper thoracic paraesophageal lymph node groups in the upper mediastinum may be complicated by damaging the recurrent laryngeal nerves. Our data regarding the vertebral level of the loop of the right recurrent laryngeal nerve across the subclavian artery are consistent with other observations [ 2 ] that it is most common at the T1 vertebral level; other investigators found it more common at the T1–T2 (43%) or T2 (43%) level [ 15 ]. As our anatomic and clinical observations show, the upper mediastinum's recurrent laryngeal nerve generally has a fairly typical course.…”

Section: Discussionsupporting

confidence: 92%

“…Topographic deviation of the posterior mediastinum in the patient’s prone position with an iatrogenically induced collapse of the right lung increases the possibility of accidental damage to critical anatomical structures that run close to the esophagus. Therefore, to safely perform thoracoscopic procedures on the esophagus, it is necessary to highlight the prominent anatomic landmarks that allow the surgeon to reliably and safely navigate through the mediastinal adipose tissue spaces near the great vessels and nerves [ 2 , 3 , 5 ]. However, a systematic description of the essential anatomic landmarks for thoracoscopic navigation during esophageal extirpation is still lacking.…”

Section: Introductionmentioning

confidence: 99%

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Mediastinal anatomical landmarks, their variants and tips for video-assisted thoracoscopic navigation during oesophageal extirpation

et al. 2021

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Purpose There is no systematic description of primary anatomical landmarks that allow a surgeon to reliably and safely navigate the superior and posterior mediastinum’s fat tissue spaces near large vessels and nerves during video-assisted endothoracoscopic interventions in the prone position of a patient. Our aim was to develop an algorithm of sequential visual navigation during thoracoscopic extirpation of the esophagus and determine the most permanent topographic and anatomical landmarks allowing safe thoracoscopic dissection of the esophagus in the prone position. Methods The anatomical study of the mediastinal structural features was carried out on 30 human cadavers before and after opening the right pleural cavity. Results For thoracoscopic extirpation of the esophagus in the prone position, anatomical landmarks are defined, their variants are assessed, and an algorithm for their selection is developed, allowing their direct visualization before and after opening the mediastinal pleura. Conclusion The proposed algorithm for topographic and anatomical navigation based on the key anatomical landmarks in the posterior mediastinum provides safe performance of the video-assisted thoracoscopic extirpation of the esophagus in the prone position.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Mediastinal anatomical landmarks, their variants and tips for video-assisted thoracoscopic navigation during oesophageal extirpation

et al. 2021

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“…A total of 53 studies ( n = 53,577 total nerves; 33,571 Right RLNs and 20,006 Left RLNs) were included: 35 intraoperative, 17 cadaveric and 1 imaging (CT) (Reed, 1943; Wade, 1955; Hunt, Poole & Reeve, 1968; Stewart, Mountain & Colcock, 1972; Skandalakis et al, 1976; Papadatos, 1978; Proye et al, 1982; Flament, Delattre & Palot, 1983; Henry et al, 1988; Menck, Grüber & Lierse, 1990; Lekacos et al, 1992; Freschi et al, 1994; Moreau et al, 1998; Sasou, Nakamura & Kurihara, 1998; Sturniolo et al, 1999; Campos & Henriques, 2000; Raffaelli, Iacobone & Henry, 2000; Watanabe et al, 2001; Watanabe et al, 2016; Monfared, Gorti & Kim, 2002; Page, Foulon & Strunski, 2003; Hermans et al, 2003; Ardito et al, 2004; Toniato et al, 2004; Spartà et al, 2004; Sciumè et al, 2005; Shindo, Wu & Park, 2005; Beneragama & Serpell, 2006; Maranillo et al, 2008; Makay et al, 2008; Serpell, Yeung & Grodski, 2009; Lee et al, 2009; Sunanda, Tilakeratne & De Silva, 2010; Shao et al, 2010; Wang et al, 2011; Kaisha, Wobenjo & Saidi, 2011; Kandil et al, 2011; Pradeep, Jayashree & Harshita, 2012; Chiang et al, 2012; Tang et al, 2012; Benouaich et al, 2012; Asgharpour et al, 2012; Silva, Siqueira & Arruda, 2013; Donatini, Carnaille & Dionigi, 2013; Satoh et al, 2013; Cai et al, 2013; Hong, Park & Yang, 2014; Yang et al, 2014; Han, Bai & Lu, 2015; Dolezel et al, 2015; Iacobone et al, 2015; Buła et al, 2015; Ngo Nyeki et al, 2015; Barczyński et al, 2015). The dates of the included studies spanned the period from 1943 to 2016.…”

Section: Resultsmentioning

confidence: 99%

“…The prevalence of the NRLN has been reported numerous times with rates ranging from 0% to 4.76% (Menck, Grüber & Lierse, 1990; Freschi et al, 1994; Moreau et al, 1998; Sasou, Nakamura & Kurihara, 1998; Sturniolo et al, 1999; Monfared, Gorti & Kim, 2002; Page, Foulon & Strunski, 2003; Makay et al, 2008; Lee et al, 2009; Kandil et al, 2011; Benouaich et al, 2012; Ngo Nyeki et al, 2015). It is essential to obtain accurate anatomical data on the NRLN if patients with this anomaly are to be assessed properly for surgical candidacy and operative planning.…”

Section: Introductionmentioning

confidence: 99%

The Non-Recurrent Laryngeal Nerve: a meta-analysis and clinical considerations

Henry

Sanna

Graves

et al. 2017

PeerJ

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BackgroundThe Non-Recurrent Laryngeal Nerve (NRLN) is a rare embryologically-derived variant of the Recurrent Laryngeal Nerve (RLN). The presence of an NRLN significantly increases the risk of iatrogenic injury and operative complications. Our aim was to provide a comprehensive meta-analysis of the overall prevalence of the NRLN, its origin, and its association with an aberrant subclavian artery.MethodsThrough March 2016, a database search was performed of PubMed, CNKI, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science. The references in the included articles were also extensively searched. At least two reviewers judged eligibility and assessed and extracted articles. MetaXL was used for analysis, with all pooled prevalence rates calculated using a random effects model. Heterogeneity among the included studies was assessed using the Chi2 test and the I2 statistic.ResultsFifty-three studies (33,571 right RLNs) reported data on the prevalence of a right NRLN. The pooled prevalence estimate was 0.7% (95% CI [0.6–0.9]). The NRLN was found to originate from the vagus nerve at or above the laryngotracheal junction in 58.3% and below it in 41.7%. A right NRLN was associated with an aberrant subclavian artery in 86.7% of cases.ConclusionThe NRLN is a rare yet very clinically relevant structure for surgeons and is associated with increased risk of iatrogenic injury, most often leading to temporary or permanent vocal cord paralysis. A thorough understanding of the prevalence, origin, and associated pathologies is vital for preventing injuries and complications.

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“…The prevalence of the NRLN has been reported numerous times with rates ranging from 0% to 4.76% (Menck, Grüber & Lierse, 1990;Freschi et al, 1994;Moreau et al, 1998;Sasou, Nakamura & Kurihara, 1998;Sturniolo et al, 1999;Monfared, Gorti & Kim, 2002;Page, Foulon & Strunski, 2003;Makay et al, 2008;Lee et al, 2009;Kandil et al, 2011;Benouaich et al, 2012;Ngo Nyeki et al, 2015). It is essential to obtain accurate anatomical data on the NRLN if patients with this anomaly are to be assessed properly for surgical candidacy and operative planning.…”

Section: Introductionmentioning

confidence: 99%

Peer Review #3 of "The Non-Recurrent Laryngeal Nerve: a meta-analysis and clinical considerations (v0.2)"

2017

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Background. The Non-Recurrent Laryngeal Nerve (NRLN) is a rare embryologically-derived variant of the Recurrent Laryngeal Nerve (RLN). The presence of a NRLN significantly increases the risk of iatrogenic injury and operative complications. Our aim was to provide a comprehensive meta-analysis of the overall prevalence of the NRLN, its origin, and its association with an aberrant subclavian artery. Methods. Through March 2016, a database search was performed of PubMed, CNKI, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science. The references in the included articles were also extensively searched. At least two reviewers judged eligibility and assessed and extracted articles. MetaXL was used for analysis, with all pooled prevalence rates calculated using a random effects model. Heterogeneity among the included studies was assessed using the Chi 2 test and the I 2 statistic. Results. Fifty-three studies (33,571 right RLNs) reported data on the prevalence of a right NRLN. The pooled prevalence estimate was 0.7% (95%CI: 0.6-0.9). The NRLN was found to originate from the vagus nerve at or above the laryngotracheal junction in 58.3% and below it in 41.7%. A right NRLN was associated with an aberrant subclavian artery in 86.7% of cases. Conclusion. The NRLN is a rare yet very clinically relevant structure for surgeons and is associated with increased risk of iatrogenic injury, most often leading to temporary or permanent vocal cord paralysis. A thorough understanding of the prevalence, origin, and associated pathologies is vital for preventing injuries and complications.

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Anatomical basis of the risk of injury to the right laryngeal recurrent nerve during thoracic surgery

Cited by 13 publications

References 20 publications

Mediastinal anatomical landmarks, their variants and tips for video-assisted thoracoscopic navigation during oesophageal extirpation

Mediastinal anatomical landmarks, their variants and tips for video-assisted thoracoscopic navigation during oesophageal extirpation

The Non-Recurrent Laryngeal Nerve: a meta-analysis and clinical considerations

Peer Review #3 of "The Non-Recurrent Laryngeal Nerve: a meta-analysis and clinical considerations (v0.2)"

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