Continuous Intraoperative Recurrent Laryngeal Nerve Monitoring in Transcervical Inflatable Mediastinoscopic Esophagectomy.

Transcervical inflatable mediastinoscopic esophagectomy (TIME), with fewer incisions and without going through the thoracic cavity, may achieve the same results and lymph node dissection compared with Thoracoscopic assisted minimally invasive esophagectomy (TAMIE). However, its small visual field increases recurrent laryngeal nerve (RLN) injury risk. Intraoperative nerve monitoring (IONM) reduces RLN paralysis in TAMIE, but few reports have used it in TIME. This paper introduces continuous IONM in TIME to protect RLN. A patient underwent TIME with continuous left RLN monitoring using an EMG endotracheal tube and APS electrode. Stimulation frequency was 1 Hz, with the alarm set at ≥ 50% EMG amplitude reduction or latency prolongation > 10%. The signals are within the normal range during the mediastinal surgery and neck anastomosis. The patient had a normal voice and symmetric vocal cord movement postoperatively. Continuous IONM in TIME may help identify and protect RLN, enabling more aggressive lymph node dissection, though it needs anesthesia cooperation to avoid muscle relaxants. It may be the best method for RLN protection in TIME in the future.