Intraoperative Neurophysiologic Testing of the Perigastric Vagus Nerve Branches to Evaluate Viability and Signals along Nerve Pathways during Gastrectomy
- Author:
Seong Ho KONG
1
;
Sung Min KIM
;
Dong Gun KIM
;
Kee Hong PARK
;
Yun Suhk SUH
;
Tae Han KIM
;
Il Jung KIM
;
Jeong Hwa SEO
;
Young Jin LIM
;
Hyuk Joon LEE
;
Han Kwang YANG
Author Information
- Publication Type:Original Article
- Keywords: Vagus nerve; Gastrectomy; Intraoperative neurophysiological monitoring
- MeSH: Diarrhea; Duodenum; Electrodes; Gastrectomy; Humans; Information Services; Intraoperative Neurophysiological Monitoring; Jejunum; Methods; Needles; Prospective Studies; Pylorus; Vagus Nerve
- From:Journal of Gastric Cancer 2019;19(1):49-61
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: The perigastric vagus nerve may play an important role in preserving function after gastrectomy, and intraoperative neurophysiologic tests might represent a feasible method of evaluating the vagus nerve. The purpose of this study is to assess the feasibility of neurophysiologic evaluations of the function and viability of perigastric vagus nerve branches during gastrectomy. MATERIALS AND METHODS: Thirteen patients (1 open total gastrectomy, 1 laparoscopic total gastrectomy, and 11 laparoscopic distal gastrectomy) were prospectively enrolled. The hepatic and celiac branches of the vagus nerve were exposed, and grabbing type stimulation electrodes were applied as follows: 10–30 mA intensity, 4 trains, 1,000 µs/train, and 5× frequency. Visible myocontractile movement and electrical signals were monitored via needle probes before and after gastrectomy. Gastrointestinal symptoms were evaluated preoperatively and postoperatively at 3 weeks and 3 months, respectively. RESULTS: Responses were observed after stimulating the celiac branch in 10, 9, 10, and 6 patients in the antrum, pylorus, duodenum, and proximal jejunum, respectively. Ten patients responded to hepatic branch stimulation at the duodenum. After vagus-preserving distal gastrectomy, 2 patients lost responses to the celiac branch at the duodenum and jejunum (1 each), and 1 patient lost response to the hepatic branch at the duodenum. Significant procedure-related complications and meaningful postoperative diarrhea were not observed. CONCLUSIONS: Intraoperative neurophysiologic testing seems to be a feasible methodology for monitoring the perigastric vagus nerves. Innervation of the duodenum via the celiac branch and postoperative preservation of the function of the vagus nerves were confirmed in most patients. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0000823
