Video‐assisted esophagectomy using a port‐free organ retractor for the prevention of laryngeal nerve paralysis

Introduction Recurrent laryngeal nerve (RLN) paralysis is a major complication of esophageal cancer surgery. The free jaw clip (FJ clip) was developed as an organ‐retracting device, and it can also reduce the number of ports required during surgery. Here, we describe a new technique for lymphadenect...

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Bibliographic Details
Published in:Asian journal of endoscopic surgery 2020-01, Vol.13 (1), p.127-130
Main Authors: Sato, Shinsuke, Nagai, Erina, Taki, Yusuke, Watanabe, Masaya, Takagi, Masakazu
Format: Article
Language:English
Subjects:
Esophageal cancer
Esophagectomy - instrumentation
Esophagectomy - methods
Esophagus
Gastrointestinal surgery
Humans
laryngeal nerve paralysis
Lymph Node Excision - instrumentation
Lymph Node Excision - methods
Lymphatic system
organ retractor
Recurrent Laryngeal Nerve - surgery
Surgical Instruments
Thoracic Surgery, Video-Assisted - instrumentation
Thoracic Surgery, Video-Assisted - methods
Vocal Cord Paralysis - etiology
Vocal Cord Paralysis - prevention & control
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Summary:Introduction Recurrent laryngeal nerve (RLN) paralysis is a major complication of esophageal cancer surgery. The free jaw clip (FJ clip) was developed as an organ‐retracting device, and it can also reduce the number of ports required during surgery. Here, we describe a new technique for lymphadenectomy along the left RLN using the FJ clip. Materials and Surgical Technique After the middle and lower mediastinal lymph nodes were dissected, the upper esophagus and other tissues, including the lymph nodes and left RLN, were retracted by cutting the tracheal arteries between the esophagus and trachea and then pulling the upper esophagus to the dorsal side with the FJ clip. The esophagus was transected at the upper mediastinum, and the proximal esophagus was drawn by the FJ clip. This technique helped provide a good field of view during lymphadenectomy along the left RLN. The data of nine consecutive patients who underwent video‐assisted esophagectomy in the left lateral decubitus position by the same surgeon were reviewed. Postoperative left RLN paralysis occurred in only one patient in whom the RLN could not be preserved. Discussion Given the excellent short‐term outcomes with respect to left RLN paralysis, lymphadenectomy along the left RLN using the FJ clip was safe and feasible.
ISSN:1758-5902
1758-5910
DOI:10.1111/ases.12684