title: Phrenic nerve reconstruction in complete video-assisted thoracic surgery.
abstract: OBJECTIVE
  Primary or metastatic lung cancer or mediastinal tumours may at times involve the phrenic nerve and pericardium. To remove the pathology en bloc, the phrenic nerve must be resected. This results in phrenic nerve paralysis, which in turn reduces pulmonary function and quality of life. As a curative measure of this paralysis and thus a preventive measure against decreased pulmonary function and quality of life, we have performed immediate phrenic nerve reconstruction under complete video-assisted thoracic surgery, and with minimal additional stress to the patient. This study sought to ascertain the utility of this procedure from an evaluation of the cases experienced to date.
  
  
  METHODS
  We performed 6 cases of complete video-assisted thoracic surgery phrenic nerve reconstruction from October 2009 to December 2013 in patients who had undergone phrenic nerve resection or separation to remove tumours en bloc. In all cases, it was difficult to separate the phrenic nerve from the tumour. Reconstruction involved direct anastomosis in 3 cases and intercostal nerve interposition anastomosis in the remaining 3 cases.
  
  
  RESULTS
  In the 6 patients (3 men, 3 women; mean age 50.8 years), we performed two right-sided and four left-sided procedures. The mean anastomosis time was 5.3 min for direct anastomosis and 35.3 min for intercostal nerve interposition anastomosis. Postoperative phrenic nerve function was measured on chest X-ray during inspiration and expiration. Direct anastomosis was effective in 2 of the 3 patients, and intercostal nerve interposition anastomosis was effective in all 3 patients. Diaphragm function was confirmed on X-ray to be improved in these 5 patients.
  
  
  CONCLUSIONS
  Complete video-assisted thoracic surgery phrenic nerve reconstruction was effective for direct anastomosis as well as for intercostal nerve interposition anastomosis in a small sample of selected patients. The procedure shows promise for phrenic nerve reconstruction and further data should be accumulated over time.
authors.affiliation: Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan skawashima-ykh@umin.ac.jp.
authors.forename: Shun
authors.initials: S
authors.lastname: Kawashima
authors.affiliation: Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Tadasu
authors.initials: T
authors.lastname: Kohno
authors.affiliation: Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Sakashi
authors.initials: S
authors.lastname: Fujimori
authors.affiliation: Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Yokomakura
authors.affiliation: Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Harano
authors.affiliation: Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Souichiro
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Iida
authors.affiliation: Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Sakai
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003964:Diaphragm / Q000294:innervation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010791:Phrenic Nerve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Interposition; Mediastinum; Phrenic nerve; Thoracoscopic surgery; Video-assisted thoracic surgery