Skip to main content
SpringerLink
Log in

Anatomical bases of left recurrent nerve lesions during mediastinoscopy

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Carlens E (1959) Mediastinoscopy: a method for inspection and tissue biopsy in the superior mediastinum. Dis Chest 36:343–352

    PubMed  CAS  Google Scholar 

  2. Coughlin M, Deslauriers J, Beaulieu M et al (1985) Role of mediastinoscopy in pretreatment staging of patients with primary lung cancer. Ann Thorac Surg 40:556–560

    Article  PubMed  CAS  Google Scholar 

  3. Detterbeck FC, Jantz MA, Wallace M et al (2007) Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132:202S–220S

    Article  PubMed  Google Scholar 

  4. Ellis PD, Pallister WK (1975) Recurrent laryngeal nerve palsy and endotracheal intubation. J Laryngol Otol 89:823–826

    Article  PubMed  CAS  Google Scholar 

  5. Filaire M, Garcier JM, Harouna Y et al (2001) Intrathoracic blood supply of the left vagus and recurrent laryngeal nerves. Surg Radiol Anat 23:249–252

    Article  PubMed  CAS  Google Scholar 

  6. Le Pimpec Barthes F, D’Attellis N, Assouad J et al (2003) Chylous leak after cervical mediastinoscopy. J Thorac Cardiovasc Surg 126:1199–1200

    Article  PubMed  Google Scholar 

  7. Lemaire A, Nikolic I, Petersen T et al (2006) Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate. Ann Thorac Surg 82:1185–1189

    Article  PubMed  Google Scholar 

  8. Leschber G, Sperling D, Klemm W et al (2008) Does video-mediastinoscopy improve the results of conventional mediastinoscopy? Eur J Cardiothorac Surg 33:289–293

    Article  PubMed  Google Scholar 

  9. Mountain CF, Dresler CM (1997) Regional lymph node classification for lung cancer staging. Chest 111:1718–1723

    Article  PubMed  CAS  Google Scholar 

  10. Riquet M (1993) Anatomic basis of lymphatic spread from carcinoma of the lung to the mediastinum: surgical and prognostic implications. Surg Radiol Anat 15:271–277

    Article  PubMed  CAS  Google Scholar 

  11. Riquet M, Manac’h D, Dupont P et al (1994) Anatomic basis of lymphatic spread of lung carcinoma to the mediastinum: anatomo-clinical correlations. Surg Radiol Anat 16:229–238

    Article  PubMed  CAS  Google Scholar 

  12. Roberts JR, Wadsworth J (2007) Recurrent laryngeal nerve monitoring during mediastinoscopy: predictors of injury. Ann Thorac Surg 83:388–391

    Article  PubMed  Google Scholar 

  13. Sortini A, Navarra G, Santini M et al (1994) Video-assisted mediastinoscopy. A new application of television technology in surgery. Minerva Chir 49:803–805

    PubMed  CAS  Google Scholar 

  14. Venissac N, Alifano M, Mouroux J (2003) Video-assisted mediastinoscopy: experience from 240 consecutive cases. Ann Thorac Surg 76:208–212

    Article  PubMed  Google Scholar 

  15. Weisberg NK, Spengler DM, Netterville JL (1997) Stretch-induced nerve injury as a cause of paralysis secondary to the anterior cervical approach. Otolaryngol Head Neck Surg 116:317–326

    Article  PubMed  CAS  Google Scholar 

  16. Widstrom A (1975) Palsy of the recurrent nerve following mediastinoscopy. Chest 67:365–366

    Article  PubMed  CAS  Google Scholar 

  17. Witte B, Wolf M, Huertgen M et al (2006) Video-assisted mediastinoscopic surgery: clinical feasibility and accuracy of mediastinal lymph node staging. Ann Thorac Surg 82:1821–1827

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The author thank Miss Tracy Chapman for kindly reviewing the manuscript, Mrs. Marie José Fouque for picture management, Mrs. Chamaillard and Mr. De Livron from Karl Storz Company for technical support, and Mr. Philippe Peugeot and Mr. Hubert for technical help.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Laboratory of Human Anatomy, Toulouse-Purpan Medical University, Université Paul Sabatier, 133 route de Narbonne, 31062, Toulouse, France

    Vincent Benouaich, Bertrand Marcheix, Luana Carfagna & Jacques Guitard

  2. Department of Thoracic Surgery, Rangueil-Larrey University Hospital, 24 chemin de Pouvourville, TSA 30031, 31059, Toulouse Cedex 9, France

    Vincent Benouaich & Laurent Brouchet

Authors
  1. Vincent Benouaich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bertrand Marcheix
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luana Carfagna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laurent Brouchet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jacques Guitard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vincent Benouaich.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Benouaich, V., Marcheix, B., Carfagna, L. et al. Anatomical bases of left recurrent nerve lesions during mediastinoscopy. Surg Radiol Anat 31, 295–299 (2009). https://doi.org/10.1007/s00276-008-0451-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-008-0451-1

Keywords

Search

Navigation