|
Back to 2015 Annual Meeting Program
Lymph-Node Dissection Along the Left Recurrent Laryngeal Nerve After Esophageal Stripping in VATS-E (Video-Assisted Thoracoscopic Surgery of Esophagus) and Safe Anastomotic Technique
Hiroshi Makino*1, Hiroshi Yoshida1, Hiroshi Maruyama1, Eiji Uchida2, Ichiro Akagi1, Masao Miyashita3
1Surgery, Nippon Medical School, Tama Nagayama Hospital, Tokyo, Japan; 2Gastro-enterological Surgery, Nippon Medical School, Tokyo, Japan; 3Surgery, Nippon Medical School, Chiba-Hokusoh Hospital, Chiba, Japan
Introduction
Video assisted thoracoscopic surgery of the esophagus (VATS-E) in prone position is available because the lung moves below by the gravity, and a good operative field is obtained. A clear operative view of the middle and lower mediastinum has been obtained; however, the working space in the upper mediastinum is limited and lymph-node dissection along the left recurrent laryngeal nerve is difficult in prone position. We report to overcome the problem by our technique and safe anastomosis.
Patients
Eighty four patients (27 in left lateral and 57 in prone position), with esophageal squamous cell carcinomas underwent VATS-E, respectively.
Methods
(1) Lymph node dissection along the lt. recurrent laryngeal nerve
At first the patients are fixed at semi-prone position because both prone and left lateral positions can be set by rotating. Three 5 mm ports and two 10 mm ports are used at the 3rd, 7th, 9th and 5 th, 7th intercostal space (ICS). The pneumothorax by maintaining CO2 insufflation pressure of 6 mmHg is made, and esophagectomy is performed in prone position. In the case of thoracotomy the patient will be rotated to the left lateral position. The lymph nodes around the trachea and bronchus, above the diaphragm and along the bilateral recurrent laryngeal nerves are dissected. Working space at the left upper mediastinal area for lymph nodes dissection around recurrent laryngeal nerve is limited in prone position. To obtain the space the residual esophagus is stripped in the reverse direction and retracted toward the neck after the stomach tube is removed through the nose.
(2) Safe Anastomotic technique in the narrow neck field
At first the circular stapler (CDH25) is introduced into the gastric conduit and joined to an anvil, and close a little because anastomosis is performed in the narrow neck field. And then an anvil is placed into the proximal esophagus and secured by means of a pursestring suture. The gastric conduit opening is closed using an additional firing of a 60 mm linear stapler and the anastomosis is completed.
Results
1. Mean estimated blood loss was 34 ml of chest procedure in prone position and mean chest operative time 322 minutes. 2. The rate of permanent recurrent laryngeal nerve paralysis was 2.8%, and anastomotic leak and postoperative pneumonia was 5.6% and 8.3%, respectively.
Conclusion
1. Lymphadenectomy along the left recurrent laryngeal nerve after esophageal stripping is available in prone position of VATS-E.
2. Our anastomotic technique is safe in the narrow neck field
Back to 2015 Annual Meeting Program
|
