“Energy-less technique” with mini-clips for recurrent laryngeal nerve lymph node dissection in prone thoracoscopic esophagectomy for esophageal cancer - 07/11/17

Doi : 10.1016/j.amjsurg.2017.10.033

Hiroshi Saeki ^⁎ , Yuichiro Nakashima, Kosuke Hirose, Shun Sasaki, Tomoko Jogo, Daisuke Taniguchi, Keitaro Edahiro, Shotaro Korehisa, Kensuke Kudou, Ryota Nakanishi, Nobuhide Kubo, Koji Ando, Akira Kabashima, Eiji Oki, Yoshihiko Maehara
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

^∗Corresponding author. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan.Department of Surgery and ScienceGraduate School of Medical SciencesKyushu University3-1-1 MaidashiHigashi-kuFukuoka812-8582Japan

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 07 November 2017
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Background

Meticulous recurrent laryngeal nerve (RLN) lymph node dissection in thoracoscopic esophagectomy for esophageal cancer often results in RLN paralysis.

Methods

We had attempted to simply cut the vessels around RLN sharply with scissors without using energy device in order to prevent RLN paralysis. However, these procedures often result in minor bleeding. Since we introduced the use of mini-clips for hemostasis before cutting the vessels with scissors, we herein compared the surgical results between before and after the introduction of use of mini-clips.

Results

With regard to RLN paralysis, the incidence was 24.0% in the before group; this incidence went down to 5.1% in the after group (P = 0.0259). Moreover, length of hospital stay after surgery was significantly shortened, from 36.1 days to 22.0 days, after the introduction of energy-less techniques with mini-clips (P = 0.0075).

Conclusions

Our data demonstrated that this technique contributed to prevent RLN paralysis and to shorten the patient's length of hospital stay.

Le texte complet de cet article est disponible en PDF.

Highlights

•	We introduced the “energy-less technique” with mini-clips for recurrent laryngeal nerve lymph node dissection.
•	The incidence of recurrent laryngeal nerve paralysis was remarkably decreased after the introduction of this technique.
•	We suggest that this decrease was caused by adequate control of minor bleeding with the mini-clips.

Le texte complet de cet article est disponible en PDF.

Keywords : Esophagectomy, Prone position, Energy device, Hemostasis, Recurrent laryngeal nerve paralysis