A strategy for using intraoperative nerve monitoring during esophagectomy to prevent recurrent laryngeal nerve palsy

Abstract

Background: There have been only sporadic reports on intraoperative nerve monitoring (IONM) during esophageal cancer surgery. We aimed to establish a strategy for the use of IONM during esophagectomy. Patients and Methods: Forty-one cases enrolled in this study. The IONM was performed before and after lymph node dissection in the thoracic cavity and cervical area. Occurrence of recurrent laryngeal nerve (RLN) palsy was assessed on the seventh postoperative day. Results: The identification of nerves using IONM was possible in all cases. The positive and negative predictive values of IOMN were 80% and 92%, respectively. Loss of response was observed during the thoracic procedure in 14 out of 16 cases, with the predominance of left RLN palsy (n=12). Conclusion: In esophageal cancer surgery, identification of the RLN using IONM can be carried out safely, simply, and promptly. Using IONM systematically, the prediction of RLN palsy and detection of nerve injury point seems feasible.