Anatomical bases of left recurrent nerve lesions during mediastinoscopy.

PURPOSE: The mechanism of left recurrent laryngeal nerve palsy after cervical mediastinoscopy remains unclear. Our aim is to describe the anatomical bases of this complication.

METHODS

Video-assisted mediastinoscopy was performed on ten fresh human cadavers with simultaneous dissection of the left recurrent nerve.

RESULTS

Three dissection areas could be described regarding the risk of left recurrent nerve damage: a low risk area, along the right wall and before the upper part of the anterior wall of the trachea; an area at high risk of indirect stretch-induced lesions, between the lower part of the anterior wall of the trachea and the aorta; -an area at high risk of direct injury, against the lower part of the left wall of the trachea.

CONCLUSIONS

Dissection between the trachea and the aorta causes traction on the left recurrent nerve. Indirect stretch-induced injury is probably a frequent mechanism of left recurrent nerve palsy during mediastinoscopy.