Mobilization of the phrenic nerve in the thoracic cavity by video-assisted thoracic surgery. Techniques and initial experience.

BACKGROUND

The use of video-assisted thoracic surgery (VATS) techniques to mobilize the phrenic nerve in the thoracic cavity for neurotization after brachial plexus injury was studied.

METHODS

From August 1999 to January 2000, 10 men and 1 woman with brachial plexus injury (left side in 5 and right side in 6) joined the study group. Their ages ranged from 20 to 38 years (average, 28 years). Supine after general anesthesia, all the patients had double-lumen trachea cannulas to guarantee complete lung collapse on the operative side. Three port incisions were made to allow introduction of the following: a 10-mm Stryker endoscope through the sixth intercostal space 2 cm medial to the anterior axillary line, one instrument for manipulation in the anterior axillary line of the third intercostal space, and another in the second intercostal space about 2 cm lateral to the parasternal line. The nerve was mobilized with two common long Mixter clamps and some endoscopic instruments by blunt and sharp dissection.

RESULTS

All patients were managed successfully without severe complications. The mean additional length of phrenic nerves by this technique was 16 cm.

CONCLUSIONS

Mobilization of the phrenic nerve by VATS is a safe and minimally invasive method for elongating the nerve for neurotization after brachial plexus injury.