Novel universally applicable technique for performing bilateral transcervical mediastinoscopic-assisted transhiatal lapa
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and Other Interventional Techniques
Novel universally applicable technique for performing bilateral transcervical mediastinoscopic‑assisted transhiatal laparoscopic esophagectomy: a truly minimally invasive procedure Hiroyuki Daiko1,2 · Junya Oguma1 · Hisashi Fujiwara2 · Koshiro Ishiyama1 · Daisuke Kurita1 · Takuji Sato2 · Kazuma Sato2 · Z. Faiz1 · Takeo Fujita2 Received: 10 May 2020 / Accepted: 16 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The procedure of mediastinoscopic-assisted transhiatal esophagectomy (MATE) is only performed in a few institutions, despite this being the ultimate form of minimally invasive surgery for performing esophagectomy for esophageal and esophagogastric cancer in that it entails no chest wall trauma. We have developed a novel, universally applicable, surgical procedure for performing bilateral transcervical mediastinoscopic-assisted transhiatal laparoscopic esophagectomy (BTC-MATLE) that is an improvement on standard MATE surgery for esophageal and esophagogastric cancer. Methods The patient is placed in a supine position under general anesthesia with bilateral lung ventilation. BTC-MATLE combined with mediastinoscopic and transhiatal laparoscopic esophagectomy with total mediastinal lymph node dissection are performed synchronously. After lymph node dissection along both recurrent laryngeal nerves through bilateral cervical skin incisions, bilateral transcervical mediastinoscopic esophagectomy is performed to avoid collision outside the cervical region and ensure operability even in patients with narrow mediastimun. Laparoscopic gastric mobilization and subsequent lower esophageal mobilization meet the bilateral transcervical mediastinoscopic esophagectomy at the border of the middle and lower third of the esophagus. The gastric tube is pulled up into the cervical region via a posterior mediastinal route and anastomosed in the neck. Results BTC-MATLE was performed on 16 high-risk patients (Charlson Comorbidity Index ≥ 3 in 14 patients and two octogenarians with complex comorbidities). Median operation time and postoperative hospital stay were 231 min and 15 days, respectively. R0 resection was achieved in 15 patients (94%), and there were no in-hospital deaths. Conclusions BTC-MATLE, a procedure for performing minimally invasive esophagectomy, is likely to become the applicable form of MATE surgery for esophageal and esophagogastric cancer, even in high-risk patients because it is truly minimally invasive and has excellent short-term outcomes. Keywords Mediastinoscopic-assisted transhiatal esophagectomy · Esophageal cancer · Esophagogastric junction cancer · Mediastinoscopy · Minimally invasive esophagectomy Development of medical technology has enabled minimally invasive surgery and improved understanding of anatomy because anatomical structures are magnified by highresolution endoscopy (microanatomy). Our procedure for * Hiroyuki Daiko [email protected] 1
Esophageal Surgery Division, National Cancer Center Hos
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