Effectiveness of Non-Energy Devices and Nerve Monitoring in Preventing Recurrent Laryngeal Nerve Injury in Lung Cancer Surgery

Abstract Systematic nodal dissection is crucial for lung cancer patients undergoing complete resection, but it carries a risk of recurrent laryngeal nerve (RLN) injury (RLNI). To protect the RLN, we utilized a combination of non-energy devices and RLN monitoring (NE-RLNM). Lung cancer patients who underwent uniportal video-assisted thoracoscopic surgery were included in the study and divided into two groups: an energy group and a NE-RLNM group. Propensity score matching was applied to balance baseline clinical data, and both intraoperative and postoperative conditions were analyzed retrospectively. Univariate and multivariate analyses were conducted to identify risk factors of RLNI. Among the 409 patients included, there were 187 in the energy group and 222 in the NE-RLNM group. After 1:1 propensity score matching, 166 pairs of patients were matched. The energy group reported shorter operative time (P<0.001) and less day 1 chest tube drainage (P=0.001)than the NE-RLNM group. However, the NE-RLNM group had a lower RLNI rate (P=0.011) and a higher recovery rate (P=0.034) than the energy group. Side of the primary tumor (OR=2.88, 95% CI: 1.20-6.88, P=0.017), pTNM stage (OR=5.62, 95% CI: 1.57-20.13, P=0.008), and surgical devices (OR=0.40, 95% CI: 0.18-0.91, P=0.029) were independent predictors of RLNI. The use of NE-RLNM appears effective in reducing RLNI incidence and improving recovery rates. Our study provides new insights into RLN preservation during complete lung cancer resection.