Preventing Recurrent Laryngeal Nerve Injury During Transhiatal Esophagectomy Through Targeted Cervical Dissection: A Case Report.

Injury to the recurrent laryngeal nerve (RLN) is a well-recognized complication of esophagectomy and is associated with significant postoperative morbidity, including dysphonia, aspiration, and pulmonary complications. The risk is particularly relevant during transhiatal esophagectomy, where limited mediastinal visualization increases the likelihood of traction-related nerve injury. We report a case of a 68-year-old male with distal esophageal carcinoma who underwent transhiatal esophagectomy following neoadjuvant therapy, in whom a targeted cervical dissection strategy was employed to achieve early identification and preservation of the left RLN. Key technical elements included lateralization of the thyroid lobe, selective ligation of small collateral vessels, traction-free cervical mobilization of the esophagus, and coordinated bidirectional cervical-abdominal dissection to minimize mediastinal strain. The gastric conduit was delivered through the posterior mediastinum, and a hand-sewn cervical esophagogastric anastomosis was completed without intraoperative complications. Postoperative laryngoscopic evaluation confirmed normal vocal cord mobility, and the patient experienced no dysphonia, aspiration, or respiratory events during recovery. This case highlights a potentially reproducible, anatomy-based cervical approach for RLN preservation during transhiatal esophagectomy that can be applied in resource-limited settings to reduce functional morbidity.