How Vulnerable is the Recurrent Laryngeal Nerve in Esophageal Surgery?

McCullagh, Majella; Edwards, M. H.

doi:10.1007/978-3-642-86432-2_99

Cited by 6 publications

(7 citation statements)

References 12 publications

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“…Previous researchers hypothesized that pulmonary arterial dilatation secondary to a wide range of cardiac disorders could be regarded as the single main factor directly responsible for left RLN palsy [1]. Again, the left RLN is considered to be at risk during esophageal resection surgeries, nodal dissection in lung cancer surgeries, and surgical closure of the patent ductus arteriosus in infants [1, 8-11]. Previous researchers tried to find an association between the RLN diameter and chances of injury during surgery [12].…”

Section: Introductionmentioning

confidence: 99%

Cadaveric Measurements of the Left Recurrent Laryngeal Nerve, Ligamentum Arteriosum, Aortic Arch, and Pulmonary Artery in the Thorax with Clinical Implications and Comparison Between Two Sexes in the American Population

Ghosh¹,

Chaudhury²

2019

Cureus

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The left recurrent laryngeal nerve (RLN) is prone to get compressed or damaged, leading to vocal cord palsy, due to pathologies or surgeries of the structures closely surrounding this nerve in the thorax, including the esophagus, aortic arch, pulmonary trunk, and ligamentum arteriosum. We wanted to provide a data set including nerve diameter, its distance from the esophagus, measurements of the pulmonary artery, aorta, and ligamentum arteriosum in close proximity of the nerve in a healthy population to avoid its damage during surgery and predict its chances of compression during the diseased condition. We measured the left RLN and the surrounding structures in 39 well-embalmed cadavers. We compared the values among the male and female cadavers. We found that the mean diameter of the left RLN was 1.75 mm, the mean distance of the nerve from esophagus was 9.88 mm, the mean diameters of the aortic arch and pulmonary artery just distal to the attachment of the ligamentum arteriosum were 26.14 and 19.93 mm, respectively, and the length and width of ligamentum arteriosum were 15.89 and 2.79 mm, respectively. No clinically significant differences were found between male and female parameters. This set of values might be useful while investigating the cause of vocal cord palsies or during surgeries in close proximity to left RLN to avoid its damage.

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Section: Introductionmentioning

confidence: 99%

Cadaveric Measurements of the Left Recurrent Laryngeal Nerve, Ligamentum Arteriosum, Aortic Arch, and Pulmonary Artery in the Thorax with Clinical Implications and Comparison Between Two Sexes in the American Population

Ghosh¹,

Chaudhury²

2019

Cureus

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“…The incidence of recurrent nerve palsy in this series is low (6.6%) compared to other series [12-36%; [4], This suggests that endodissection may be less traumatizing to upper mediastinal structures than con ventional THE.…”

Section: Discussionmentioning

confidence: 61%

“…Con sequently, an advance in transhiatal esophageal surgery is warranted because during conventional THE (a) visual control during dissection of the thoracic esophagus is poor, especially above the level of the tracheal bifurcation; (b) the incidence of recurrent nerve palsy is unsatisfactory in many centers [4] and (c) mediastinal lymphadenectomy cannot be performed.…”

Section: Discussionmentioning

confidence: 99%

“…Transhiatal esophagectomy (THE), in turn, has been advocated by several centers [1][2][3] because it avoids thoracotomy, shortens the operation time and pro motes the patient's postoperative pulmonary perfor mance. However, THE is a less radical approach than TTE, carries a high risk of recurrent laryngeal nerve palsy [4] and has no cardiopulmonary advantages over TTE in controlled studies [5].…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Esophagectomy: A Better Way to Atraumatic Surgery?

Bumm¹,

Hölscher²,

Siewert³

1993

Dig Surg

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This paper describes the technique and clinical results of endoscopic dissection (endodissection) of the thoracic esophagus during transhiatal esophagectomy (THE). The method eliminates the ‘blind angle’ of conventional THE and reduces intraoperative traction on mediastinal tissues. Mediastinal structures such as the trachea, main bronchi and mediastinal nerves can be identified, and bleeding from minor mediastinal vessels can be controlled under vision. The mortality rate of the first 30 patients operated on was 6.6%, and only two major intraoperative complications occurred (one lesion of the right main bronchus, 2 bleedings). The rate of recurrent nerve palsy in these patients was low (6.6%).

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“…Hauptpr/idilektionsstellen sind, neben der Verletzungsm6glichkeit wfihrend der cerv~calen Pr/iparation, Bereiche hinter der Trachealbifurkation und dem Aortenbogen [11]. Das intrathorakale Drittel wird aus kleineren Arterien gespeist, die den tracheo-bronchialen und bronchialen Arterien aus dem Aortenbogen und dem cranialen Abschnitt der intrathorakalen Aorta entspringen (Abb.…”

Section: Mefizeitpunlcteunclassified

Die endoskopisch-mikrochirurgische Dissektion der Speiseröhre: ein Beitrag zur Reduzierung pulmonaler Komplikationen nach Oesophagusresektion?

Kipfmüller

Duda²,

Kessler³

et al. 1990

Langenbecks Arch Chir

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A new endoscopic microsurgical technique for dissection of the esophagus has been developed and tried out in animals. With this technique the esophagus is dissected and removed via a cervical approach by means of a new operating endoscope. In a randomized animal study we compared endoscopic versus blunt dissection and versus abdominothoracic resection. During endoscopic dissection we saw significantly lower bleeding and no laceration of the pleural cavity or damage to the recurrent laryngeal or to the vagus nerve. Significant changes of hemodynamics or gas exchange were observed in the blunt dissection group: increase of heart frequency, decrease of arterial pressure and decrease of paO2. In contrast these parameters did not change in the endoscopic group.

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How Vulnerable is the Recurrent Laryngeal Nerve in Esophageal Surgery?

Cited by 6 publications

References 12 publications

Cadaveric Measurements of the Left Recurrent Laryngeal Nerve, Ligamentum Arteriosum, Aortic Arch, and Pulmonary Artery in the Thorax with Clinical Implications and Comparison Between Two Sexes in the American Population

Cadaveric Measurements of the Left Recurrent Laryngeal Nerve, Ligamentum Arteriosum, Aortic Arch, and Pulmonary Artery in the Thorax with Clinical Implications and Comparison Between Two Sexes in the American Population

Endoscopic Esophagectomy: A Better Way to Atraumatic Surgery?

Die endoskopisch-mikrochirurgische Dissektion der Speiseröhre: ein Beitrag zur Reduzierung pulmonaler Komplikationen nach Oesophagusresektion?

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