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The vagal nerve (VN) can easily be detected, preserved, and intentionally resected below the separation point of the recurrent laryngeal nerve (RLN). However, postoperative vocal cord paresis can result from vagal or RLN injury during radical lymph node dissection, presenting a challenge to the operating surgeon.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>From May to August 2019, 10 cases of robot-assisted minimally invasive esophagectomy (RAMIE) with extended 2-field lymphadenectomy, performed at the University Medical Center Mainz, were included in a prospective cohort study. Bilateral intermittent intraoperative nerve monitoring (IONM) of the RLN and VN was performed, including pre- and postoperative laryngoscopy assessment.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Reliable mean signals of the right VN (2.57\u00a0mV\/4.50\u00a0ms) and the RLN (left 1.24\u00a0mV\/3.71\u00a0ms, right 0.85\u00a0mV\/3.56\u00a0ms) were obtained. IONM facilitated the identification of the exact height of separation of the right RLN from the VN. There were no cases of permanent postoperative vocal paresis. Median lymph node count from the paratracheal stations was 5 lymph nodes.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>IONM was feasible during RAMIE. The intraoperative identification of the RLN location contributed to the accuracy of lymph node dissection of the paratracheal lymph node stations. RLN damage and subsequent postoperative vocal cord paresis can potentially be prevented by IONM.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00423-020-01990-0","type":"journal-article","created":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T06:02:54Z","timestamp":1600927374000},"page":"1091-1099","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Recurrent laryngeal nerve monitoring during totally robot-assisted Ivor Lewis esophagectomy"],"prefix":"10.1007","volume":"405","author":[{"given":"J. I.","family":"Staubitz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. 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Peter P. Grimminger is proctor for Intuitive Surgical. All the co-authors have nothing to disclose; neither received funding. The authors also had freedom of investigation and full control of the design of the study, the methods used, the outcome parameters and results, the analysis of data, and the production of the written report.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}