Page 6 - Read Online

Kobayashi et al. Mini-invasive Surg 2020;4:30 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.12

Original Article Open Access

Cause of recurrent laryngeal nerve paralysis

following esophageal cancer surgery and preventive
surgical technique along the left recurrent laryngeal
nerve

Hiroyuki Kobayashi, Masato Kondo, Ryosuke Kita, Hiroki Hashida, Keiichi Shiokawa, Kentaro Iwaki,
Hiroyuki Kambe, Ryosuke Mizuno, Takuma Kawarabayashi, Tokihiko Sumi, Satoshi Kaihara, Ryo
Hosotani

Department of Surgery, Kobe City Medical Center General Hospital, Kobe City 650-0047, Japan.

Correspondence to: Dr. Hiroyuki Kobayashi, Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1
Minatojma-minamimachi, Chuo-ku, Kobe City 650-0047, Japan. E-mail: hiro64151@kcho.jp
How to cite this article: Kobayashi H, Kondo M, Kita R, Hashida H, Shiokawa K, Iwaki K, Kambe H, Mizuno R, Kawarabayashi T,
Sumi T, Kaihara S, Hosotani R. Cause of recurrent laryngeal nerve paralysis following esophageal cancer surgery and preventive
surgical technique along the left recurrent laryngeal nerve. Mini-invasive Surg 2020;4:30.
http://dx.doi.org/10.20517/2574-1225.2020.12

Received: 16 Jan 2020 First Decision: 20 Mar 2020 Revised: 2 Apr 2020 Accepted: 8 Apr 2020 Published: 16 May 2020
Science Editor: Itasu Ninomiya Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Aim: Recurrent laryngeal nerve paralysis (RLNP) after esophageal cancer surgery, especially on the left, is a major
clinical challenge. We believe that the use of intra-operative neural monitoring can help us to learn and identify
surgical maneuvers that can cause RLNP, so as to improve the postoperative course for patients. Thus, the aim of
this study was to determine the causes of RLNP and to devise a preventive surgical technique.

Methods: Radical esophageal cancer surgery was performed with intra-operative neural monitoring at our
institution from July 2015 to January 2019. The cause(s) of RLNP was investigated by video analysis, which
enabled a preventive technique to be developed and introduced. Short-term surgical outcomes of the modified and
conventional surgical methods were compared.

Results: RLNP occurred in 10/57 (17.5%) of cases. The causes of paralysis were traction (n = 5), compression
(n = 3), thermal injury (n = 1), and compression in cervical procedure (n = 1). Subsequently, 20 surgeries were
performed between February and December 2019 using the modified technique and there was only one case (5%)
of RLNP.

Conclusion: The main causes of RLNP are compression and traction. Our modified technique for esophageal
cancer surgery substantially decreases the incidence of RLNP post-operatively.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

www.misjournal.net