Intraoperative recurrent laryngeal nerve monitoring during video-assisted thoracoscopic surgery for patent ductus arteriosus

Objective: To develop a technique to identify and localize the recurrent la ryngeal nerve (RLN) during video-assisted thoracoscopic surgery (VATS) for patent ductus arteriosus. Design: Prospective clinical study. Setting: Children's hospital. Participants:Sixty infants and children scheduled for elective closure of p atent ductus arteriosus. Interventions: With parental informed consent, 60 infants and children unde rgoing elective VATS for patent ductus arteriosus were studied. A thin, pen cil-point, Teflon-coated, stimulating probe allowed direct stimulation (<2 mA, 100-msec pulse width) of the left RLN inside the thorax. A commercially available 4-channel neurologic monitor recorded compound evoked electromyo grams (EMGs) from the left RLN and right RLN (as control) by needle electro des placed percutaneously in the neck. Hoarseness, strider, feeding difficu lties, and voice changes were assessed postoperatively. Mesrsurements and Main Results: Left RLN EMGs were easily obtained in 59 of the 60 patients. The surgeon correctly identified the RLN visually once in the first 7 patients; this ability subsequently improved. EMG localization of the location or course of the RLN altered dissection, clip size, or cli p position in 37 of 59 patients. Conclusion: Intraoperative EMG to identify location and route of the RLN wa s easy to perform, was effective in identifying RLN position, and appeared to facilitate dissection and clipping of the ductus. Copyright (C) 2000 by WB. Saunders Company.