A cadaveric study of intrathoracic harvesting of the phrenic nerve under endoscope

Objective To investigate the potential and practicability of providing long donor nerve for neurotization in brachial plexus avulsion injuries by means of endoscopic intrathoracic harvesting of the phrenic nerve. Methods Fifteen fresh cadavers were studied. 15 sides were dissected to observe the course of the phrenic nerve in the thoracic cavity and its relation to the surrounding structures. The other 15 sides were used for endoscopic approach and harvesting of the phrenic nerve. The thoracic endoscope was inserted into the thoracic cavity at the point lateral to the midclavicular line at the 5th to 6th intercostal space. The phrenic nerve was cut off 2 cm proximal to the diaphragm and pulled out from the supraclavicular incision. Results Four to five branches could be seen at the site 2 cm proximal to the diaphragm. If the phrenic nerve was cut off there, a segment 19 cm to 25 cm in length could be harvested without obstacles. In this study, none of the phrenic nerve was ruptured when it was pulled out from the thoracic cavity. Conclusions This method is easy and safe. The study provides a new surgical method to harvest long phrenic nerve for repair of brachial plexus avulsion injuries.