Chylothorax and recurrent laryngeal nerve injury associated with robotic video-assisted mediastinal lymph node dissection Journal Article
| Authors: | Sarkaria, I. S.; Finley, D. J.; Bains, M. S.; Adusumilli, P. S.; Rizk, N. P.; Huang, J.; Downey, R. J.; Rusch, V. W.; Jones, D. R. |
| Article Title: | Chylothorax and recurrent laryngeal nerve injury associated with robotic video-assisted mediastinal lymph node dissection |
| Abstract: | Objective: Although the technical aspects of robotic video-assisted thoracic surgery (RVATS) for lung resections may be advantageous, compared with standard thoracoscopy, complications of chylothorax and recurrent laryngeal nerve injury (RLNI) associated with mediastinal lymph node dissection (MLND) may be significant. Methods: Consecutive patients who underwent RVATS anatomic lung resection for suspected or confirmed cancer and experienced RLNI or chylothorax were identified and reviewed from a prospectively maintained database. Complications were graded according to the Common Terminology Criteria for Adverse Events version 3.0. Results: From July 28, 2010, to December 20, 2013, 251 patients underwent RVATS segmentectomy, lobectomy, or bilobectomy with MLND. Eleven patients (4.4%) experienced MLND-related complications and composed the study group; 81.8% were right-sided resections, and the median lymph node counts in right station IV and station VII were 9 (range, 1-23) and 5.5 (range, 1-10); 72.7% of the cases were performed for early-stage I and II lung cancers. Chylothorax [6/251 (2.4%)] and RLNI [6/251 (2.4%)] were significantly more common in the RVATS group than in the open thoracotomy and standard VATS groups. Complications requiring procedural intervention (Grade 3) are as follows: 4 cases of RLNI in patients undergoing percutaneous vocal cord medialization and 3 cases of chylothorax in patients undergoing image-guided thoracic duct embolization or maceration. No operative interventions were required. Conclusions: RVATS MLND may be associated with increased rates of chylothorax and RLNI. Attention must be paid to identifying potential technical pitfalls with RVATS lung resections, adjusting surgical techniques accordingly, and minimizing patient morbidity. Copyright © 2015 by the International Society for Minimally Invasive Cardiothoracic Surgery. |
| Keywords: | controlled study; major clinical study; artificial embolism; conference paper; cancer staging; lymph node dissection; prospective study; disease association; lung resection; thoracotomy; incidence; lung cancer; complications; lobectomy; vats; thoracoscopy; video assisted thoracoscopic surgery; robotic surgery; mediastinal lymph node dissection; chylothorax; bilobectomy; recurrent laryngeal nerve injury; human; priority journal; segmentectomy; robot assisted surgery; robotic video assisted mediastinal lymph node dissection; thoracic duct embolization |
| Journal Title: | Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery |
| Volume: | 10 |
| Issue: | 3 |
| ISSN: | 1556-9845 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2015-05-01 |
| Start Page: | 170 |
| End Page: | 173 |
| Language: | English |
| PROVIDER: | scopus |
| PUBMED: | 26165562 |
| DOI: | 10.1097/IMI.0000000000000160 |
| PMCID: | PMC4981881 |
| DOI/URL: | |
| Notes: | Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, May 28-31, 2014 in Boston, MA -- Export Date: 2 November 2015 -- Source: Scopus |
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