A useful method to keep azygos arch in minimally invasive resection of esophageal leiomyoma

Abstract

Lifting azygos arch with a prolene line is a useful way to keep azygos arch in minimally invasive resection of esophageal leiomyoma without affecting surgical exposure and operative procedure. J Thorac Dis 2017;9(11):4589-4591 jtd.amegroups.com arch. After the azygos vein was fully freed, 4-0 prolene line was threaded through the azygos vein. ENDO CLOSE needle (product number: T173022, COVIDIEN company) was inserted in the posterior axillary line at the fourth intercostal space to catch the prolene line and bring the prolene line out of the chest. After that, the end of prolene line was pulled to vertically sling the azygos vein and fixed on a sterile surgical towel (Figure 2). Thus, the surgical field below the azygos vein could be fully exposed. The surgeon used the ultrasonic knife to open the esophageal fibrous membrane, muscular. The tumor was separated from esophageal mucosa with blunt dissection using "pea nut" which was made with sterile gauze. After checking bleeding and the integrity of esophageal mucosa, the esophageal muscular layer and the mediastinal pleura were closed with interrupted sutures to prevent postoperative diverticular formation. We provided a surgery video containing detailed procedure for you to refer to ( Figure 3).After surgery, digital gastrointestinal imaging showed no esophageal thoracic cavity fistula. The final pathologic examination demonstrated that the mass was leiomyoma. The results of immunohistochemical stains showed positive stains for smooth muscle actin and Desmin and negative stains for CD117, CD34 and DOG-1. Besides, Ki-67 was 1% positive stains. The stomach tube was extubated on the third day, and the patient started a liquid diet. The patients could have normal diets with no symptom of dysphagia and regurgitation three months later. CommentsIt was reported that about 30% to 33% of esophageal leiomyomas were found in the middle thoracic esophagus (4,5). Digital gastrointestinal imaging, thoracic CT and EUS are need to be performed to identify the tumor type. Minimally invasive techniques have become leading approaches to remove esophageal leiomyoma for decreasing postoperative complications, improving postoperative pain control and shorting hospital stays (4). For leiomyoma in the middle thirds of the esophagus, cutting azygos vein in minimally invasive surgeries has been recommended in many articles, because it can benefit surgical exposure and facilitate operations in resecting leiomyoma (1,5). However, cutting azygos vein alters venous circulation. And the instrument is needed during operation to push the azygos vein arch stub away for a better surgical exposure. We indicate a useful surgical technique, vertical sling of the azygos vein, which can fully expose surgical field without

Factors Affecting Blood Loss During Thoracoscopic Esophagectomy for Esophageal Carcinoma

“…In our data, however, no significant relationships were confirmed between these factors and AAP (Supplementary Table 1). AAP during thoracic esophagectomy is an uncommon technique that has been described in only a few publications to date [21,28]. Whether AAP is clinically justified was rarely discussed until the recent study by Fujiwara et al [29], who comparatively analyzed the relationship between surgical outcomes and AAP in 119 patients undergoing MIE for EC and, interestingly, suggested that the achievement of AAP during thoracoscopic esophagectomy might enhance post-surgical urinary output.…”