**9.3 Cervical plate design**

A plate can cause postoperative dysphagia due to mass effect or induction of inflammation, plate redesign to a low profile by decreasing its thickness will endure a minimization of postoperative dysphagia [22]. Equally, the use of a zero profile cage and plate or hybrid cage has shown a smaller incidence of postoperative dysphagia [49].

#### **9.4 Tracheal traction exercises**

The concept behind the preoperative tracheal traction exercise is to increase the compliance of the esophagus, thereby reducing the pressure required by retraction to expose an adequate operative field, the exercises were performed twice daily (15 times each time) for three days, starting four days before the operation [50].

#### **9.5 Surgical techniques**

An effort to limit the operative time should be undertaken to decrease the postoperative dysphagia. Appropriate surgical training should focus on acquiring a sound knowledge of anatomical variation of the RLN & SLN, a meticulous plan by plan surgical dissection, control of blood loss to better identify anatomical structures, avoid excessive blade retraction to reduce mechanical transmural esophageal pressure and anchoring the blades under the dissected longus coli to avoid injury to RLN and SLN [11, 48, 51].
