Brachial plexus paralysis after thoracoscopic esophagectomy for esophageal cancer in the prone position: A thought-provoking case report of an unexpected complication

International Journal of Surgery Case Reports, 2019 · DOI: https://doi.org/10.1016/j.ijscr.2018.12.001 · Published: January 9, 2019

Anesthesiology Surgery Research Methodology & Design

Simple Explanation

The case report discusses an instance of brachial plexus paralysis following a thoracoscopic esophagectomy performed in the prone position to treat esophageal cancer. This is a rare complication that has not been previously documented in the literature. The patient, a 58-year-old man, experienced difficulty moving his right arm post-surgery. Imaging revealed injury to the right posterior cord of the brachial plexus at the costoclavicular space, which was attributed to the patient's positioning during the procedure. The patient underwent rehabilitation and recovered completely within two months. The report emphasizes the importance of careful patient positioning during surgery to avoid such complications.

Study Duration

Not specified

Participants

A 58-year-old man

Evidence Level

Level 4, Case Report

Key Findings

1
Brachial plexus injury can occur during thoracoscopic esophagectomy in the prone position, likely due to excessive abduction and external rotation of the arm.
2
MRI revealed nerve injury at the costoclavicular space, and a positive Eden’s test suggested anatomical compression in the thoracic outlet.
3
Modified arm positioning, including moderating abduction and keeping the head slightly turned rightward, may help prevent nerve extension and injury.

Research Summary

This case report describes a previously undocumented complication of brachial plexus paralysis following thoracoscopic esophagectomy in the prone position. The injury was likely caused by the patient's intraoperative position, specifically excessive abduction and external rotation of the arm, leading to nerve compression or extension. The authors suggest careful attention to patient positioning, including modified arm and head orientation, to prevent such injuries during similar procedures.

Practical Implications

Surgical Positioning

Emphasizes the importance of meticulous patient positioning during thoracoscopic esophagectomy to prevent brachial plexus injuries.

Diagnostic Awareness

Highlights the need for clinicians to be aware of brachial plexus injury as a potential complication and to conduct thorough examinations if symptoms arise.

Rehabilitation Strategies

Underlines the effectiveness of rehabilitation in achieving full recovery from brachial plexus paralysis.

Study Limitations

1
Single case report limits generalizability.
2
Specific factors contributing to the injury may be unique to the patient's anatomy or surgical technique.
3
Lack of a control group to compare outcomes with modified positioning techniques.

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