Minimal Bipolar Use During Anterior Scalenectomy Will Save the Phrenic Nerve - ASPN
Amgad S Hanna, MD1, Mark Kraemer, MD2, Kelsey Bowman, MD2 and Stephanie Wilbrand, MD2, (1)Neurosurgery, University of Wisconsin, Madison, WI, (2)University of Wisconsin, Madison, WI
Introduction:
Phrenic nerve injury is often encountered in iatrogenic and traumatic injuries. Patients may develop shortness of breath, atelectasis and occasionally pneumonia. Transient nerve palsy has been reported in supraclavicular brachial plexus explorations, however, the incidence, etiology and clinical implications are poorly understood. We hypothesized the use of electrocautery during anterior scalenectomy may cause transient nerve dysfunction. Here we report a prospective series of patients who underwent anterior scalenectomy for thoracic outlet syndrome using traditional and a modified electrocautery-sparing approach.
Methods:
Beginning in April 2018, all patients undergoing scalenectomy for thoracic outlet decompression underwent routine pre- and post-operative chest x-rays. In the first period of the study, patients underwent decompression using a traditional surgical technique with use of the bipolar electrocautery during division of the anterior scalene. In the second period of the study, a modified electrocautery-sparing approach was used with muscle resection performed sharply with scissors. Detailed clinical, radiographic and surgical findings are discussed.
Results:
Thirteen patients underwent thoracic outlet decompression during the study period, five were performed using the traditional technique and 8 using the modified electrocautery-sparing technique. All five patients who underwent traditional decompression developed radiographic evidence of phrenic nerve palsy with one patient developing shortness of breath. Diaphragm position normalized and symptoms resolved in all patients 6 months after surgery. None of the patients undergoing decompression using the modified electrocautery-sparing approach developed radiographic or clinical evidence of phrenic nerve palsy. This was statistically significant, X2 (1, N = 13, p = 0.0003). There were no complications using the modified scalenectomy technique, notably no increased bleeding.
Conclusion:
Phrenic nerve palsy is a common complication after thoracic outlet decompression with radiographic evidence of injury. A modified electrocautery-sparing approach during anterior scalenectomy will likely decrease the risk of phrenic nerve injury.
Back to 2021 ePosters