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2007 Program and Abstracts | 2007 Posters
New Approach, for Totally Endoscopic (Laparoscopic and Thoracoscopic) En-Bloc Esophagectomy with the Complete Three-Field Dissection
Hitoshi Satodate*, Haruhiro Inoue, Shin-Ei Kudo
Yokchama, Japan

It has been reported that the techniques of esophagectomy is critical because those are directly reflected to postoperative outcome. 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. With advent of minimal access surgery, a myriad of different approaches have been devised and studied in recent years. Thoracoscopic esophageal mobilization is one of the most popular approaches.Hand-assisted laparoscopic surgery (HALS) for gastric conduit preparation, modified 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 nerves as they course through the mediastinum and 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 contribute 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.Between April 2004 and December 2006, we had performed this procedure for 52 cases of esophageal cancer patient. The difference of survival rate and morbidity rate are now under investigation, but our impression is favorable.These new two techniques, ropeway technique and double gloving method for HALS, are feasible for totally endoscopic en-bloc esophagectomy with the complete three-field dissection and also potentially contribute to safer procedures.


2007 Program and Abstracts | 2007 Posters
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