Cervical‐First Approach in Thoracoscopic Esophagectomy With Intraoperative Nerve Monitoring for an Esophageal Cancer Patient With Aberrant Right Subclavian Artery

• DOI: 10.1111/ases.70018
• Publication Date: 2025-01-06T06:21:46Z
• Authors: Masato Mochizuki; Shigeru Tsunoda; Shintaro Okumura; Tatsuto Nishigori; Shigeo Hisamori; Keiko Kasahara; Takashi Sakamoto; Hiromitsu Kinoshita; Yoshiro Itatani; Nobuaki Hoshino; Ryosuke Okamura; Hisatsugu Maekawa; Koya Hida; Kazutaka Obama
• Keywords: Esophagectomy; Thoracoscopy

An aberrant right subclavian artery (ARSA) is a rare vascular anomaly accompanied by nonrecurrent inferior laryngeal nerve (NRILN). Here, we described the cervical-first approach in thoracoscopic esophagectomy for an esophageal cancer patient with ARSA using intraoperative monitoring (IONM) system. First, left cervical procedure proceeded to expose vagus attach APS electrode of IONM system, and paraesophageal lymph nodes was dissected separately. Subsequently, NRILN identified system tracing vagal intermittent manual stimulation. In procedures, traced cranially from bronchial bifurcation, dissection continued through cervicothoracic border up without difficulty. Continuous can ensure safe upper mediastinal ensuring recurrent integrity narrow mediastinum. The postoperative course uneventful and, discharged on Day 21. patients ARSA, method safer alternative, dorsal over esophagus useful restricted space