What Happens in (the) Vagus, Stays in (the) Vagus
DOI:
https://doi.org/10.1532/hsf.3073Abstract
Many cardiothoracic operations put the nerves of the thorax at risk. In fact, nerve injuries are one of the most common reasons cited in malpractice cases brought against cardiothoracic surgeons. While all physicians learn about the nerves of the thorax during anatomy courses in medical school, little is written about avoiding injury to these important nerves in the cardiothoracic surgical literature. We have, therefore, embarked on an effort to collate information on the anatomy, function, and protection of these nerves, with which every cardiothoracic surgeon should be familiar. We will call this effort “The Nerve Protection Project.” Acknowledging that the material to be covered is considerable, we will break the project into a series of editorials. The first installment in this series will address the anatomy and function of the vagus nerve and the protection of this nerve and its branches during cardiothoracic surgical operations, as they are in harm’s way during many of these procedures.
References
A good time to reflect on the wisdom that was Woody [Hayes] [blog].
Amer K. 2017. The recurrent laryngeal nerves and the thoracic surgeon. [accessed 2019 Dec 18]. https://figshare.com/articles/The_Recurrent_Laryngeal_Nerves_and_the_Thoracic_Surgeon/5345176.
Aynehchi B, McCoul E, Sundaram K. 2010. Systematic review of laryngeal reinnervation techniques. Otolaryngol Head Neck Surg 143:749-59.
Banki F, Mason R, DeMeester S, et al. 2002. Vagal-sparing esophagectomy: a more physiological alternative. Ann Surg 236:324-36.
Crema E, Terra Júnior J, Borges M, Queiroz C, Soares L, da Silva A. 2018. Preservation of the vagus nerves in subtotal esophagectomy without thoracotomy. Acta Cir Bras 33:834-41.
Davis Z, Jacobs H, Bonilla J, Anderson R, Thomas C, Forst W. 2000. Retaining the aortic fat pad during cardiac surgery decreases postoperative atrial fibrillation. Heart Surg Forum 3:108-12.
Engel J, Spellberg M. 1978. Complications of vagotomy. Am J Gatroenterol 70:55-60.
Filaire M, Mom T, Laurent S, et al. 2001. Vocal cord dysfunction after left lung resection for cancer. Eur J Cardiothorac Surg 20:705-11.
Gable D, Brinkman W. 2018. LSA preservation during TEVAR: insights from the international GREAT registry: An overview of our experience with the Conformable GORE® TAG® Thoracic Endoprosthesis. Endovascular Today 17(March 2018 suppl):17-20.
Henry B, Hsieh W, Sanna B, Vikse J, Taterra D, Tomaszewski K. 2019. Incidence, risk factors, and comorbidities of vocal cord paralysis after surgical closure of a patent ductus arteriosus: a meta-analysis. Pediatr Cardiol. 40:116-25.
Hung W, Cheng C, Huang C. 2017. Prevention of recurrent laryngeal nerve injury with intraoperative nerve monitoring during esophageal cancer surgery. J Thorac Dis 9(suppl 14):S1419.
Ikeguchi M, Watanabe J, Kuroda H, et al. 2011. Operative procedure for laparoscopy-assisted vagus nerve and pylorus-preserving gastrectomy (LAVNPPG) for early gastric cancer. Yonago Acta Med 54:59-63.
Isseroff T, Pitman M. 2013. Optimal management of acute recurrent laryngeal nerve injury during thyroidectomy. Curr Otorhinolaryngol Rep 1:163-70.
Jellish WS, Oftadeh M. 2018. Peripheral nerve injury in cardiac surgery. J Cardiothorac Vasc Anes 32:495-511.
Jiang Y, Gao B, Zhang X, et al. 2014. Prevention and treatment of recurrent laryngeal nerve injury in thyroid surgery. Int J Clin Exp Med 7:101-7.
Kaplan K. 2011 Aug 17. What types of doctors are most likely to get sued? [accessed 2019 Dec 23]. https://www.latimes.com/health/la-xpm-2011-aug-17-la-heb-medical-malpractice-claims-specialty-20110817-story.html.
Laccourreye O, Malinvaud D, Delas B, et al. 2010. Early unilateral laryngeal paralysis after pulmonary resection with mediastinal dissection for cancer. Ann Thorac Surg 90:1075-8.
Liebermann-Meffert D, Walbrun B, Heibert C, Siewert J. 1999. Recurrent and superior laryngeal nerves: a new look with implications for the esophageal surgeon. Ann Thorac Surg 67:217-23.
Li H, Hu Y, Huang J, Yang Y, Xing K, Luo Q. 2018. Attempt of peripheral nerve reconstruction during lung cancer surgery. Thorac Cancer. 9:580-3.
Nichter L, Bryant C, Kenney J, et al. 1984. Injuries to commercial electric current. J Burn Care Rehab 5:124-37.
Pourmoghadam K, DeCampli W, Ruzmetov M, et al. 2017. Recurrent laryngeal nerve injury and swallowing dysfunction in neonatal aortic arch repair. Ann Thorac Surg 104:1611-8.
Roberts J, Wadsworth J. 2007. Recurrent laryngeal nerve monitoring during mediastinoscopy: predictors of injury. Ann Thorac Surg 83:388-91.
Scholtemeijer M, Seesing M, Brenkman H, Janssen L, van Hillegersberg R, Ruurda J. 2017. Recurrent laryngeal nerve injury after esophagectomy for esophageal cancer: incidence, management, and impact on short- and long-term outcomes. J Thorac Dis 9(suppl 8):S868-78.
Sharma A, Parmley C, Sreeram G, Grocott H. 2000. Peripheral nerve injuries during cardiac surgery: risk factors, diagnosis, prognosis, and prevention. Anesth Analg 91:1358-69.
Stakenborg N, Di Giovangiulio M, Boeckxstaens G, Matteoli G. 2013. The versatile role of the vagus nerve in the gastrointestinal tract. EMJ Gastroenterol 1:106-14.
Svensson E, Horvath-Puho E, Thomsen R, et al. 2015. Vagotomy and subsequent risk of Parkinson’s disease. Ann Neurol 78:522-9.
van Rijn S, Roebroek Y, Conchillo J, Bouvy N, Masclee A. 2016. Effect of vagus nerve injury on the outcome of antireflux surgery: an extensive literature review. Dig Surg 33:230-9.
Weinreb S. 2019 Oct 25. What is the vagus nerve? Everything you need to know. USA Today. Life section. [accessed 2019 Dec 19].
