Abstract
To reduce pulmonary complications after esophagectomy, the transthoracic procedure should be shortened or totally avoided. Transcervical approach assisted by mediastinoscope for the upper mediastinum may be advantageous for this purpose. We carried out video‐assisted transcervical mediastinal dissection (VATCMD) as part of totally non‐transthoracic radical esophagectomy. A single‐port laparoscopy device was adopted to a small cervical incision and the mediastinum was inflated with a positive pressure of 6 to 10 mmHg. Without assistant's retractor, the upper mediastinum and partially the middle mediastinum were dissected mainly by mediastinoscopic‐assisted surgery. Video of the operation is demonstrated with illustrations. We have carried out and reported 17 cases of esophagectomy including VATCMD and its perioperative outcome. Non‐transthoracic esophagectomy was completed without conversion to transthoracic procedure in all 17 cases. Procedure‐related adverse event was not observed and postoperative course was favorable with a zero occurrence (0%) of recurrent laryngeal nerve palsy, chyle leakage or pulmonary complications. Median number of harvested lymph nodes from the upper mediastinal stations was 10. VATCMD is suggested as a safe and feasible approach for the upper mediastinum in esophagectomy for malignancies. It enabled a totally non‐transthoracic radical esophagectomy in combination with a transhiatal approach.Video‐assisted transcervical mediastinal dissection is suggested as a safe and feasible approach for the upper mediastinum in esophagectomy for malignancies. It enabled a totally non‐transthoracic radical esophagectomy in combination with a transhiatal approach.
Highlights
Progress has been made in the surgical technique of esophagectomy and its surgical mortality has drastically decreased.[1,2,3] Minimally invasive esophagectomy such as video-assisted surgery can reduce chest wall trauma and has been reported to reduce surgical mortality, preserve pulmonary function and improve patients’ postoperative quality of life.[1,4,5] video-assisted transthoracic esophagectomy is technically demanding and its perioperative outcome depends on the skill of the surgeon.[6,7]In an effort to eliminate surgical mortality after esophagectomy, the most essential point is reduction of pulmonary complications
We describe the details of the video-assisted transcervical mediastinal dissection (VATCMD) with illustrations and a video
RLN, recurrent laryngeal nerve; VATCMD, video-assisted transcervical mediastinal dissection. aTotal number of upper mediastinal lymph nodes retrieved by both VATCMD and a right cervical procedure
Summary
Progress has been made in the surgical technique of esophagectomy and its surgical mortality has drastically decreased.[1,2,3] Minimally invasive esophagectomy such as video-assisted surgery can reduce chest wall trauma and has been reported to reduce surgical mortality, preserve pulmonary function and improve patients’ postoperative quality of life.[1,4,5] video-assisted transthoracic esophagectomy is technically demanding and its perioperative outcome depends on the skill of the surgeon.[6,7]. Conventional transhiatal esophagectomy is associated with increased recurrent laryngeal nerve injury and inadequate mediastinal lymph dissection.[11,12] For transhiatal esophagectomy to be a feasible surgery for esophageal malignancies, it should preserve an adequate surgical view of the upper mediastinum. In such a background, use of the mediastinoscope in the upper retromediastinum has been attempted and mediastinoscopic upper mediastinal dissection has been suggested to be feasible with an excellent surgical view.[13,14,15,16] Above all, the technique using a singleincision laparoscopic surgery device described by Fujiwara et al.[15] was highly reproducible.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
