Hiroshi Yoshida1, Hiroshi Makino1, Hiroshi Maruyama1, Tadashi Yokoyama1, Atsushi Hirakata1, Junji Ueda1, Hideyuki Takada1, Takeshi Matsutani2, Tsutomu Nomura2, Nobuyuki Sakurazawa3, Masao Miyashita3, Eiji Uchida2. 1Department of Surgery, Nippon Medical School, Tama Nagayama Hospital, 2Department of Gastrointestinal and Hepato biliary pancreatic surgery, Nippon Medical School Hospital, 3Department of Surgery, Nippon Medical School, Chiba Hokusoh Hospital
Background: The working space in the upper mediastinum is limited and lymph-node(L.N.) dissection along the left recurrent laryngeal nerve is difficult despite of a clear operative view of the middle and lower mediastinum in prone position VATS-E(Video-Assisted Thoracoscopic Surgery of Esophagus). Anastomosis by a circular stapler in the narrow neck field is difficult. We report our technique of the L.N. dissection along the left recurrent laryngeal nerve and safe anastomosis.
Methods:
(1) Patients
One hundred ten patients (27 in left lateral and 83 in prone position), with esophageal carcinomas underwent VATS-E, respectively.
(2) Methods
i)VATS-E in prone position
At first the patients are fixed at semi-prone position and esophagectomy is performed in prone position that can be set by rotating and 5 ports are used at the intercostal space (ICS). Esophagectomy and the L.N. dissection are performed with pneumothorax by maintaining CO2 insufflation.
ii)L.N. dissection around left recurrent laryngeal nerve
Working space at the left upper mediastinal area for L.N. 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.
iii) Anastomosis
At first the circular stapler is introduced into the gastric conduit and joined to an anvil, and close a little. And then a joined anvil is placed into the proximal esophagus and secured by means of a pursestring suture. The gastric conduit opening is closed by a linear stapler, and the anastomosis is completed.
Results:
1. Mean estimated blood loss was 38 ml of chest procedure in prone position and mean chest operative time 305 minutes.
2. The rate of permanent recurrent laryngeal nerve paralysis was 2.6%, and anastomotic leak and postoperative pneumonia was 4.2% and 3.5%, respectively.
Discussion:
1. L.N. dissection along the left recurrent laryngeal nerve after esophageal stripping is available in prone position of VATS-E.
2. Our anastomotic technique is safe.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80880
Program Number: P399
Presentation Session: Poster (Non CME)
Presentation Type: Poster
