Introduction: The concept of three-field lymph node dissection for esophageal cancer was developed by Japanese surgeons and now the three-field esophagectomy is in the mainstream of the esophageal cancer surgery in Japan, and also in the various countries. With advent of minimal access surgery, a myriad of different approaches have been devised and studied in recent years. Thoracoscopic esophageal mobilization is becoming popular approaches.
Methods: Hand-assisted laparoscopic surgery (HALS) for gastric conduit preparation, modified radical cervical node dissection and cervical esophagogastrostomy followed by thoracoscopic esophagectomy through the right chest is the authors practice. Recently we added two new methods toward complete and safe lymph node dissection. One is for excision of the nodes along both recurrent laryngeal nerves as they course through the mediastinum to the neck. Both recurrent nerves are taped after the neck dissection, and the tapes are extracted thoracic cavity during the thoracoscopic procedure. Then the tapes are retracted by the forceps and nodes along to the recurrent nerves are thoroughly excised. This procedure is also contributed to the protection of the nerves. We named this method as ropeway technique, because the nerves can be seen as ropeways after the completion of the dissection. Another one is new HALS method, named as double gloving method for HALS. With this method, thorough lymph node dissection of the lower mediastinum can be securely performed.
Results: Between April 2004 and October 2007, we had performed this procedure for 76 cases of esophageal cancer patient. After introduction of this method, the operation time has become shorter and the complication rate, especially hoarseness has decreased.
Conclusions: These new two techniques, ropeway technique and double gloving method of HALS are feasible for endoscopic esophagectomy with the three-field lymph node dissection and also contribute to safer procedures.