The usefulness of a bilateral trans-cervical pneumomediastinal approach for mediastinoscopic radical esophagectomy: a right transcervical approach is an available option

Tokairin, Yutaka; Nakajima, Yasuaki; Kawada, Kenro; Hoshino, Akihiro; Okada, Takuya; Ryotokuji, Tairo; Matsui, Toshihiro; Nagai, Kagami; Kawano, Tatsuyuki; Kinugasa, Yusuke

doi:10.1007/s11748-019-01179-3

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…Upper mediastinal lymph node dissection has been performed using bilateral open cervical surgery and a left transcervical and transhiatal pneumomediastinal approach in some institutions [19,20] . However, in the results of our clinical trial, the right recurrent nerve lymph nodes, the upper thoracic paraesophageal lymph nodes, and the subaortic arch to the left tracheobronchial lymph nodes could not be completely dissected using the left transcervical approach alone [17,18] . We are therefore of the opinion that a right cervical pneumomediastinal approach is necessary to achieve the complete dissection of these lymph nodes.…”

Section: Introductionmentioning

confidence: 74%

“…The subaortic arch to the left tracheobronchial lymph nodes is dissected using the crossover technique, as described previously [15][16][17][18] . The crossover technique consists of the transhiatal, right transcervical, and/or left transcervical approach and is suitable for dissection in narrow and relatively deep operative fields, as the approach can be made from two directions.…”

Section: Dissection Of the Subaortic Arch To The Left Tracheobronchial Lymph Nodesmentioning

confidence: 99%

“…However, due to the blind maneuvering in the upper and middle mediastinum that is necessary in this procedure and the difficulty of systematic lymph node dissection, it is usually only applied in limited cases, such as cases of esophagogastric junction cancer, very early-stage cancers, or some cases of advanced thoracic esophageal cancer for the purpose of palliative resection [12] . Recently, we developed and reported the performance of "mediastinoscopic esophagectomy with lymph node dissection (MELD)" under pneumomediastinum using a bilateral transcervical and transhiatal approach, as a method of radical esophagectomy [15][16][17][18] . This procedure achieves curative radical esophagectomy with minimal invasiveness.…”

Section: Introductionmentioning

confidence: 99%

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Mediastinoscopic esophagectomy with lymph node dissection using a bilateral transcervical and transhiatal pneumomediastinal approach

Tokairin¹,

Nakajima²,

Kawad³

et al. 2020

MIS

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We developed a method for mediastinoscopic esophagectomy via a bilateral transcervical and transhiatal approach under pneumomediastinum as a less-invasive radical operation. The right recurrent nerve is first identified using an open approach, and the right cervical paraesophageal lymph nodes and part of the right recurrent nerve lymph nodes are dissected, after which pneumomediastinum is initiated. The upper thoracic paraesophageal lymph nodes and right recurrent nerve lymph nodes are dissected along the right vagus nerve. The dorsal side of the esophagus is dissected along the visceral sheath taking care to avoid thoracic duct injury and is then dissected along the vascular sheath in front of the descending aorta. The esophagus is dissected from the trachea at the caudal side of the aortic arch, and then dissected along the ventral side of the left main bronchus, reaching the pulmonary artery. Finally, the right recurrent nerve lymph nodes around the right subclavian artery are completely retrieved. The left cervical approach is almost the same as that via the right side. The dorsal side of the esophagus is almost dissected along the visceral sheath with a right transcervical approach. The subaortic arch to the left tracheobronchial lymph nodes are dissected using the crossover technique. These lymph nodes are easily dissected by cutting the left and ventral side of the lymph nodes because the caudal side is already dissected in the right transcervical approach. A bilateral (especially right trans-cervico-pneumomediastinal) approach is useful for bilateral upper mediastinal lymph node dissection and esophagectomy.

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Section: Introductionmentioning

confidence: 74%

Section: Dissection Of the Subaortic Arch To The Left Tracheobronchial Lymph Nodesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mediastinoscopic esophagectomy with lymph node dissection using a bilateral transcervical and transhiatal pneumomediastinal approach

Tokairin¹,

Nakajima²,

Kawad³

et al. 2020

MIS

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“…18 Tokharian reported that it might be impossible to successfully remove some of the right cervical and upper mediastinal paraoesophageal lymph nodes without using the right transcervical pneumomediastina approach. 19 The bilateral (especially right-sided) transcervical pneumomediastina approach is therefore an option for achieving sufficient upper mediastinal lymph node dissection. Our innovative operation was performed through the left and right cervical approaches cooperatively.…”

Section: Discussionmentioning

confidence: 99%

Transhiatal bilateral cervical approach for mediastinoscopy‐assisted esophagectomy: A retrospective cohort study

Jiang,

Xing,

Teng

et al. 2024

World j. surg.

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BackgroundThe McKeown minimally invasive esophagectomy (McMIE) procedure has various limitations, including surgical contraindications and a high rate of postoperative pulmonary complications. A novel mediastinoscopic esophagectomy procedure was described in this study by using esophageal invagination and a transhiatal and bilateral cervical approach (EITHBC).MethodsAccording to the mode of operation, a total of 259 patients were divided into two groups, among which 106 underwent EITHBC and 153 underwent McMIE. The number of lymph nodes dissected, intraoperative outcomes, and postoperative outcomes were compared between the two groups of patients.ResultsThe results revealed that the average number of resected lymph node in the EITHBC group was significantly higher in the recL106 and TbL106 stations (recL106: 1.75 vs. 1.51, p = 0.016, TbL106: 1.53 vs. 1.19, p = 0.016) and significantly lower in the 107 stations (1. 74 vs. 2. 07, p < 0.001) than in the McMIE group. The intraoperative blood loss in the EITHBC group was significantly lower than that in the McMIE group (63.30 vs. 80.45 mL, p < 0.001). The incidence of postoperative pulmonary complications in the EITHBC group was lower than that in the McMIE group (14.15% vs. 27.45%, p = 0.008). The incidence of recurrent laryngeal nerve paralysis in the EITHBC group was significantly higher than that in the McMIE group (26.41% vs. 10.46%, p = 0.003).ConclusionCompared with the McMIE procedure, the EITHBC procedure has advantages in terms of removing the upper mediastinal lymph nodes and reducing postoperative pulmonary complications.

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“…Tokairin et al (5) explored the value of dissecting right cervical and upper mediastinal paraesophageal lymph nodes in patients with stage I-III thoracic esophageal cancer with a right transcervical pneumomediastinal approach. Here, the mediastinal paraesophageal tissues are almost skeletonized after the mediastinal lymph nodes are completely removed.…”

Section: Mobilization Of the Mediastinum Via The Right Cervical Esophagusmentioning

confidence: 99%

Radical minimally invasive esophagectomy for esophageal cancer via transcervical and transhiatal approaches: a narrative review

Wang

Yang

2021

J Thorac Dis

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Objective: Minimally invasive esophagectomy (MIE) has been widely applied for the treatment of esophageal carcinoma. It is much less invasive, as it avoids employing a transthoracic procedure.Background: MIE via transcervical and transhiatal approaches has been adopted in our center. In this approach, with the assistance of single-port techniques or robotic-assisted surgical systems, the esophagus is mobilized under visualization, which is followed by the removal of esophageal and mediastinal lymph nodes.Methods: Increasing the surgical space by mediastinal insufflation or by elevation of the sternum with a hook may improve intraoperative identification of tissues and facilitate intraoperative mobilizations. The procedure can be performed simultaneously via both cervical and abdominal approaches without the need for intraoperative turning of the patient, which shortens the operative time. Also, there is no need for thoracotomy or single-lung ventilation, which avoids disturbance to the respiratory and circulation systems.Conclusions: Suitable instruments, especially state-of-the-art energy instruments, facilitate surgical separation and hemostasis. This surgical procedure has become increasingly sophisticated over the past decade, and its modular operation has been widely recognized. The feasible place of the neck-esophageal hiatus rendezvous is on the left main bronchus around the subcarinal region. Here we describe the technical features, key steps, and necessary precautions of this minimally invasive surgery for esophageal carcinoma.

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The usefulness of a bilateral trans-cervical pneumomediastinal approach for mediastinoscopic radical esophagectomy: a right transcervical approach is an available option

Cited by 7 publications

References 19 publications

Mediastinoscopic esophagectomy with lymph node dissection using a bilateral transcervical and transhiatal pneumomediastinal approach

Mediastinoscopic esophagectomy with lymph node dissection using a bilateral transcervical and transhiatal pneumomediastinal approach

Transhiatal bilateral cervical approach for mediastinoscopy‐assisted esophagectomy: A retrospective cohort study

Radical minimally invasive esophagectomy for esophageal cancer via transcervical and transhiatal approaches: a narrative review

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