Research ArticleOpen Access

Mediastinoscopic Upper Mediastinal Lymph Node Dissection for Cervical Esophageal Carcinoma Using the LeftCervicalApproachUnder Pneumomediastinumin Thiel-Embalmed Cadavers

Volume 6 - Issue 3

Yutaka Tokairin¹*, Yasuaki Nakajima¹, Kenro Kawada¹, Akihiro Hoshino¹, Takuya Okada¹, Tairo Ryotokuji¹, Yuichiro Kume¹, Yudai Kawamura¹, Kazuya Yamaguchi¹, Kagami Nagai¹, Keiichi Akita² and Yusuke Kinugasa¹

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- ¹ Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Japan
- ²Department of Clinical Anatomy, Tokyo Medical and Dental University, Japan
*Corresponding author: Yutaka Tokairin, Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan

Received: June 28, 2018;; Published: July 09, 2018

DOI: 10.26717/BJSTR.2018.06.001362

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Abstract

Background: It is often difficult to perform complete upper mediastinal dissection for cervical esophageal cancer in the normal cervical surgery view. If a method to perform upper mediastinal dissection, including the left recurrent nerve lymph nodes (106recL), can be developed, then it may be possible to preform minimal invasive surgery without sternal splitting incisions or esophagectomy under right thoracotomy. We herein describe a new method for performing complete dissection of the upper mediastinal lymph nodes for cervical esophageal cancer under the pneumomediastinum using cadavers.

Methods: We developed a method for performing complete meidiastinoscopic upper mediastinal lymph node dissection for cervical esophageal carcinomain six Thiel-embalmed cadavers.

Procedures: A left cervical collar incision was made and open surgery on the left side was subsequently changed to the Pneumomediastinumin method after identifying the left recurrent nerve. The Alexis wound retractor was placed and deployed, and a single-port laparoscopic access device was then attached. The Pneumomediastinumin was then established and the 106recL lymph nodes were dissected along the left common carotid artery, subclavian artery, thoracic duct and the left recurrent nerve. The esophageal wall was divided from the membranous trachea. The Pneumomediastinumin can create a good view and lead to complete dissection of the upper mediastinum lymph nodes.

Discussion: We herein demonstrated that the upper mediastinal lymph node can be dissected usinglefttranscervical approach under Pneumomediastinumin and named this method “transcervicalmediastinoscopicupper-mediastinallymphnode dissection” (TCM-UMLD).TCM-UMLD is therefore considered to be a useful modality based on our experience with Thiel-embalmed human cadavers.

Keywords: Cervical Esophageal Cancer; Lymph Node Dissection; Mediastinal Lymph Node Dissection; Mediastinoscopy; Pneumomediastinum