Nerve Identification in Esophageal and Thoracic Surgery: Insights From the “Anatomy on the Border” Expert Consensus Meeting

Introduction: Advancements in minimally invasive robot-assisted surgery have considerably improved the precision of anatomical recognition. Nonetheless, variations in anatomical interpretation persist among surgical specialties, particularly in overlapping regions such as the thoracic cavity. This study aimed to elucidate differences in nerve recognition between esophageal and thoracic surgeons in Japan. Methods: A questionnaire-based survey was conducted as part of the “Anatomy on the Border” initiative by the Japan Society for Endoscopic Surgery. Responses were obtained from 78 esophageal surgical institutions (57%) and 62 thoracic surgical institutions (49%). The survey included seven items related to nerve identification, challenges in visualization, and techniques for nerve preservation. Results: Nearly all respondents deemed recurrent laryngeal nerve identification to be important or very important. Esophageal surgeons had higher recognition rates for the esophageal branches and recurrent laryngeal nerve, whereas thoracic surgeons more frequently identified the phrenic nerve, sympathetic trunk, and pulmonary branches of the vagus nerve. Nerve injury prevention strategies also differed: esophageal surgeons commonly performed nerve integrity monitoring and were more selective with energy devices, whereas thoracic surgeons emphasized anatomical knowledge. The rate of nerve integrity monitoring usage was notably higher in esophageal surgery (40%) than in thoracic surgery (11%). Conclusion: This cross-disciplinary study highlights different approaches and perceptions regarding nerve identification in thoracic surgery. The promotion of dialogue and knowledge sharing between esophageal and thoracic surgeons can potentially improve anatomical understanding and surgical safety.