Intraoperative nerve monitoring during minimally invasive esophagectomy and 3-field lymphadenectomy: Safety, efficacy and feasibility

Purpose: To demonstrate the safety, efficacy and feasibility of intraoperative monitoring of the recurrent laryngeal nerves during thoracoscopic and robotic 3-field esophagectomies. Methods This is a retrospective analysis of our initial experience with intra operative nerve monitoring during minimally invasive 3-field esophagectomies. Data were obtained from a prospectively maintained database and electronic medical records. To compare outcomes between IONM and non IONM group Fischer’s exact test was used. All patients underwent a minimally invasive(VATS/Robotic) transthoracic esoohagectomy with a neck anastomosis (McKeown procedure). Intraoperative nerve monitoring was carried out under general anesthesia with assisted ventilation and avoiding use of neuromuscular blockers during the period of nerve monitoring. Results 24 patients underwent nerve monitoring during minimally invasive 3-field esophagectomy. 15 patients were operated thoraco-laparosopically and 9 patients underwent a robotic-assisted procedure. 8/24 (33.3%) patients had vocal cord paresis in the immediate post op period. When we compared this to a historical cohort operated in the preceding 5 years in the same institution, we demonstrated a 26% reduction in nerve palsy rate(p-0.08). On follow-up, 6/8 patients reported returning to a normal voice. Conclusions Intra-operative neuro monitoring (IONM) is feasible during minimally invasive 3- field esophagectomy. Using this can potentially lead to a reduced rate of recurrent nerve palsies and a higher nodal yield.