Surgical anatomy of the supracarinal esophagus based on a minimally invasive approach: vascular and nervous anatomy and technical steps to resection and lymphadenectomy

Autor: Miguel A. Cuesta, Harushi Osugi, Nicole van der Wielen, Suzanne S. Gisbertz, Ronald L. A. W. Bleys, Peter van Duijvendijk, Donald L. van der Peet, Jennifer Straatman, Jelle P. Ruurda, Mark I. van Berge Henegouwen, Richard van Hillegersberg, Teus J. Weijs
Přispěvatelé: Surgery, CCA - Cancer Treatment and quality of life, AGEM - Re-generation and cancer of the digestive system, AGEM - Digestive immunity, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA -Cancer Center Amsterdam
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Zdroj: Surgical Endoscopy, 31(4), 1863. Springer New York
Surgical Endoscopy
Surgical Endoscopy and Other Interventional Techniques, 31(4), 1863-1870. Springer New York
Cuesta, M A, van der Wielen, N, Weijs, T J, Bleys, R L A W, Gisbertz, S S, van Duijvendijk, P, van Hillegersberg, R, Ruurda, J P, van Berge Henegouwen, M I, Straatman, J, Osugi, H & van der Peet, D L 2017, ' Surgical anatomy of the supracarinal esophagus based on a minimally invasive approach : vascular and nervous anatomy and technical steps to resection and lymphadenectomy ', Surgical Endoscopy and Other Interventional Techniques, vol. 31, no. 4, pp. 1863-1870 . https://doi.org/10.1007/s00464-016-5186-1
Surgical endoscopy, 31(4), 1863-1870. Springer New York
ISSN: 0930-2794
DOI: 10.1007/s00464-016-5186-1
Popis: Background: During esophageal dissection and lymphadenectomy of the upper mediastinum by thoracoscopy in prone position, we observed a complex anatomy in which we had to resect the esophagus, dissect vessels and nerves, and take down some of these in order to perform a complete lymphadenectomy. In order to improve the quality of the dissection and standardization of the procedure, we describe the surgical anatomy and steps involved in this procedure. Methods: We retrospectively evaluated twenty consecutive and unedited videos of thoracoscopic esophageal resections. We recorded the vascular anatomy of the supracarinal esophagus, lymph node stations and the steps taken in this procedure. The resulting concept was validated in a prospective study including five patients. Results: Seventy percent of patients in the retrospective study had one right bronchial artery (RBA) and two left bronchial arteries (LBA). The RBA was divided at both sides of the esophagus in 18 patients, with preservation of one LBA or at least one esophageal branch in all cases. Both recurrent laryngeal nerves were identified in 18 patients. All patients in the prospective study had one RBA and two LBA, and in four patients the RBA was divided at both sides of the esophagus and preserved one of the LBA. Lymphadenectomy was performed of stations 4R, 4L, 2R and 2L, with a median of 11 resected lymph nodes. Both recurrent laryngeal nerves were identified in four patients. In three patients, only the left recurrent nerve could be identified. Two patients showed palsy of the left recurrent laryngeal nerve, and one showed neuropraxia of the left vocal cord. Conclusions: Knowledge of the surgical anatomy of the upper mediastinum and its anatomical variations is important for standardization of an adequate esophageal resection and paratracheal lymphadenectomy with preservation of any vascularization of the trachea, bronchi and the recurrent laryngeal nerves.
Databáze: OpenAIRE
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