Clinical Impact of Continuous Recurrent Laryngeal Nerve Monitoring During Single-Port Mediastinoscopic Radical Esophagectomy for Esophageal Cancer

Background Although single-port mediastinoscopic radical esophagectomy is ultimate minimally invasive surgery for esophageal cancer without thoracotomy or the thoracoscopic approach, the high incidence of recurrent laryngeal nerve (RLN) palsy remains a pivotal clinical issue. Methods This study included 67 patients who underwent non-robotic or robotic assisted single-port mediastinoscopic radical esophagectomy with mediastinal lymphadenectomy between March 2019 and December 2024. Among these, continuous nerve monitoring (CNM) for RLN was done in 50 patients (CNM group), while the remaining 17 patients underwent without CNM (non-CNM group). We present our inventive surgical techniques with CNM, and the clinical benefits of CNM for RLN were evaluated. Results In all enrolled patients, the median operation time was 420 min. Mean estimated blood loss was 160 mL. Anastomotic leakage was 1.5% (1/67). The overall incidence of postoperative RLN palsy was 11.9% (8/67). The CNM group showed a significantly lower incidence of postoperative RLN palsy as compared to the non-CNM group (P = 0.021: CNM vs. non-CRNM: 6.0% (3/50) vs. 29.4% (5/17)). The CNM group had a lower incidence of postoperative pneumoniae and shorter days of postoperative hospital stay (CNM 13 days). Multivariate analysis revealed that the CNM use (odds ratio 0.07) was an independent factor avoiding postoperative RLN palsy. Conclusion The CNM for RLN contributes to a remarkable reduction in the risk of postoperative RLN palsy and improvement in outcomes in single-port mediastinoscopic radical esophagectomy.