title: Preserving the pulmonary vagus nerve branches during thoracoscopic esophagectomy.
abstract: Pulmonary vagus branches are transected as part of a transthoracic esophagectomy and lymphadenectomy for cancer. This may contribute to the development of postoperative pulmonary complications. Studies in which sparing of the pulmonary vagus nerve branches during thoracoscopic esophagectomy is investigated are lacking. Therefore, this study aimed to determine the feasibility and pitfalls of sparing pulmonary vagus nerve branches during thoracoscopic esophagectomy.
  
  
  
  In 10 human cadavers, a thoracoscopic esophagectomy was performed while sparing the pulmonary vagus nerve branches. The number of intact nerve branches, their distribution over the lung lobes and the number and location of the remaining lymph nodes in the relevant esophageal lymph node stations (7, 10R and 10L) were recorded during microscopic dissection.
  
  
  
  A median of 9 (range 5-16) right pulmonary vagus nerve branches were spared, of which 4 (0-12) coursed to the right middle/inferior lung lobe. On the left side, 10 (3-12) vagus nerve branches were spared, of which 4 (2-10) coursed to the inferior lobe. In 8 cases, lymph nodes were left behind, at stations 10R and 10L while sparing the vagus nerve branches. Lymph nodes at station 7 were always removed.
  
  
  
  Sparing of pulmonary vagus nerve branches during thoracoscopic esophagectomy is feasible. Extra care should be given to the dissection of peribronchial lymph nodes, station 10R and 10L.
authors.affiliation: Department of Surgery Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
authors.forename: Teus J
authors.initials: TJ
authors.lastname: Weijs
authors.affiliation: Department of Surgery Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
authors.forename: Jelle P
authors.initials: JP
authors.lastname: Ruurda
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: Misha D P
authors.initials: MD
authors.lastname: Luyer
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: Grard A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.affiliation: Department of Surgery Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
authors.forename: Sylvia
authors.initials: S
authors.lastname: van der Horst
authors.affiliation: Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Ronald L A W
authors.initials: RL
authors.lastname: Bleys
authors.affiliation: Department of Surgery Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands. r.vanhillegersberg@umcutrecht.nl.
authors.forename: Richard
authors.initials: R
authors.lastname: van Hillegersberg
mesh_terms: D002102:Cadaver; D004210:Dissection / Q000379:methods; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008168:Lung / Q000294:innervation*; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology; D059351:Organ Sparing Treatments / Q000379:methods*; D011183:Postoperative Complications / Q000601:surgery; D014630:Vagus Nerve
keywords: Mediastinal lymphadenectomy; Pulmonary complications; Pulmonary nerves; Thoracoscopic esophagectomy