1．食道癌手術における反回神経麻痺予防のデバイス

Intraoperative Nerve Monitoring System during Esophagectomy to Prevent Recurrent Laryngeal Nerve Palsy

食道癌術後に発生する反回神経（recurrent laryngeal nerve：RLN）麻痺は，声帯筋の運動障害を生じる結果，嗄声による患者の生活の質（QOL）の低下や時に致命的な呼吸器合併症を呈することがある1，2）．神経の誤認や術中操作による物理的な損傷が主な原因であると考えられているが，術中損傷の有無を判定する方法は確立されておらず，十分な対策が講じられていないのが現状である．

Recurrent laryngeal nerve （RLN） palsy can result in motility disorders of the vocal cord muscles and/or fatal respiratory complications. Procedures aimed at checking for intraoperative RLN injuries have not been established. Intraoperative nerve monitoring （IONM） informs electromyographic activity of the vocal cord muscles to a surgeon by visual and aural signals. In this chapter, we introduce methods for using IONM during esophageal cancer surgery.

Since we introduced IONM, several cases in which surgeons have had difficulty visually identifying the RLN have been reported. In those cases, the RLN was definitively identified using IONM. IONM can be used safely, simply, and promptly during esophageal cancer surgery for identifying the RLN to prevent and predict postoperative RLN palsy. This useful device is possible to improve the safety of the surgical procedures subsequently.