Direct-Vision Retrosternal Dissection Using the Kent Retractor for Sternal Re-Entry

Kuwaki, Kenji; Tsukamoto, Masaru; Komatsu, Katsuya; Sakata, Junichi; Muraki, Satoshi; Abe, Tomio

doi:10.1007/s00595-004-2743-3

Cited by 2 publications

(2 citation statements)

References 6 publications

(4 reference statements)

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“…Several reports have demonstrated the utility of the Kent retractor, which enables anterior sternal elevation for retrosternal space surgery [5,10]. By lifting the sternum with a Kent retractor, we were able to extend the retrosternal space and perform a safe operation with videoscope assistance.…”

Section: Discussionmentioning

confidence: 97%

Video-assisted surgery for gastric carcinoma arising in a gastric tube reconstructed retrosternally

et al. 2011

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Advances in diagnostic and surgical techniques have improved the prognosis of esophageal cancer, but there is growing concern about gastric tube cancer after esophagectomy. Gastric carcinoma arising in tubes that were reconstructed retrosternally is usually resected through a median sternotomy; however, this is invasive and carries a risk of osteomyelitis after suture-line failure. We performed video-assisted gastric tube resection, eliminating the need for sternotomy by using a sternal lifting method, on a 71-year-old man who had previously undergone esophagectomy and reconstruction retrosternally. The tumor was a Borrmann type 1 advanced cancer located near the esophagogastric anastomosis. Neck collar and upper abdominal incisions were made, and the sternum was lifted using a Kent retractor to extend the retrosternal space. Under videoscope assistance, we stripped the adhesions around the gastric tube carefully and performed total gastric tube resection. For the reconstruction, the ileocolon was lifted through the retrosternal space, and an ileoesophagostomy and Roux-en-Y reconstruction were performed. Despite leakage from an esophago-ileoanastomosis on postoperative day 6, the patient recovered well without mediastinitis or osteomyelitis of the sternum. Thus, our surgical procedure provides a good surgical view, decreases surgical stress, and reduces the risk of fatal postoperative complications.

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Section: Discussionmentioning

confidence: 97%

Video-assisted surgery for gastric carcinoma arising in a gastric tube reconstructed retrosternally

et al. 2011

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“…Several reports have demonstrated the utility of the Kent retractor, which enables anterior sternal elevation for surgery involving the upper mediastinal space. 23,24 However, there have been no previous reports about the effectiveness of lymphadenectomy after CRT using the Kent retractor for upper mediastinum lymph node metastasis of esophageal cancer. In the present case, although the tumor was located between the trachea and the third thoracic vertebrae, where it was diffi cult to approach via a cervical incision, we were able to achieve a good surgical fi eld using the Kent retractor, which allowed us to successfully resect the tumor.…”

Section: Discussionmentioning

confidence: 99%

Lymphadenectomy via a cervical approach for upper mediastinal lymph node recurrence of esophageal cancer: Report of a case

et al. 2011

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Although there have been several reports about salvage esophagectomy after definitive chemoradiotherapy (CRT), the effectiveness of lymphadenectomy for lymph node recurrence after CRT has not been fully evaluated. Radiation-induced tissue injury and fibrosis make lymphadenectomy after CRT difficult, therefore the choice of surgical approach should be considered carefully. We performed lymphadenectomy via a cervical approach in a 76-year-old man with upper mediastinal lymph node recurrence. He had previously undergone subtotal esophagectomy for squamous cell carcinoma of the upper thoracic esophagus. At 33 months after the operation, left upper mediastinal lymph node recurrence occurred. After localized CRT with docetaxel plus 60 Gy radiation, the tumor disappeared. However, at 1 year after CRT a lymph node recurrence, measuring 10 mm in size, was found in the same position on a computed tomography (CT) scan and (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) without other recurrences. Lymphadenectomy was performed via a left cervical approach using a Kent retractor to extend the surgical view of the cervicothoracic region. The patient was discharged without complications, and a postoperative CT scan and FDG-PET revealed complete resection of the tumor. In conclusion, our surgical procedure provides a good surgical view, and decreases surgical stress and the incidence of postoperative complications.

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Direct-Vision Retrosternal Dissection Using the Kent Retractor for Sternal Re-Entry

Cited by 2 publications

References 6 publications

Video-assisted surgery for gastric carcinoma arising in a gastric tube reconstructed retrosternally

Video-assisted surgery for gastric carcinoma arising in a gastric tube reconstructed retrosternally

Lymphadenectomy via a cervical approach for upper mediastinal lymph node recurrence of esophageal cancer: Report of a case

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