title: Recurrent laryngeal nerve monitoring during thoracoscopic esophagectomy.
abstract: BACKGROUND
  There have been several reports on the feasibility and curability of thoracoscopic esophagectomy, which may reduce injury to the thoracic cage and decrease the invasiveness of surgery. Although the recurrent laryngeal nerve (RLN) is identified and kept intact during operations, RLN palsy sometimes occurs. Currently, surgical aides, including intraoperative neurological monitoring, are being utilized to avoid RLN injury during thyroid surgery. This system is utilized during thoracoscopic esophagectomy in the prone position.
  
  
  METHODS
  Seven consecutive patients (six men, one woman; age range 62-74 years; mean 68 years) were included. Patients underwent general anesthesia and were intubated using the NIM TriVantage™ electromyography (EMG) tube. One-lung ventilation was performed with an endobronchial blocker. Thoracoscopic esophagectomy was performed in the prone position. The nerve stimulator was calibrated to 0.5 mA, and after the RLN was visually identified it was subsequently stimulated, which also confirmed normal machine functioning. In some situations, in the absence of a response, stimuli were increased to 1.0 mA and then 2.0 mA.
  
  
  RESULTS
  Intraoperatively, all seven patients had their nerve signals monitored. In one case, a nerve signal disappeared after complete lymph node dissection along the left RLN. This system could identify the site of injury, and the thoracoscopic magnified view allowed the disrupted point to be located precisely. When we checked VTR after surgery, the source of injury was one point tension of the nerve pulled by fiber during lymph node dissection.
  
  
  CONCLUSIONS
  Intraoperative RLN monitoring during thoracoscopic esophagectomy in the prone position, with one-lung ventilation performed using the TriVantage™ EMG tube and a bronchial blocker, is technically feasible, easy, and reliable.
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan, yikeda@med.teikyo-u.ac.jp.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Taisuke
authors.initials: T
authors.lastname: Inoue
authors.forename: Estushi
authors.initials: E
authors.lastname: Ogawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Horikawa
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Inaba
authors.forename: Ryoji
authors.initials: R
authors.lastname: Fukushima
mesh_terms: D000368:Aged; D004576:Electromyography; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D016684:Prone Position; D011446:Prospective Studies; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control*; D013906:Thoracoscopy / Q000009:adverse effects; D016896:Treatment Outcome