Video-assisted thoracoscopic esophagectomy for oesophageal cancer involving the thoracic region has certain advantages. However, thoracoscopic instrument manipulations performed in the narrow confines of the posterior mediastinum carry the risk of intraoperative injury to other vital structures.Purpose of the studyTo improve surgical treatment outcomes of thoracic oesophageal cancer patients using topographic anatomical navigation.Materials and methodsThe study included 23 patients with stages II-III middle and lower thoracic oesophageal cancer (TOC), according to TNM-8. All of them underwent thoracoscopic oesophagectomy in the semi-prone position. While the 1st group of patients (n=15) underwent conventional surgery, in the 2nd group of patients (n= 8), our algorithm of sequential visual navigation based on topographic and anatomical landmarks was employed.ResultsIn the 1st group,4 patients (26.7%) developed intraoperative complications. Out of these four, in 3 patients, injury of the thoracic lymphatic duct complicated with chylothorax development was diagnosed, requiring reoperations; in one patient, the surgery caused damage to the thoracic aorta. Unfortunately, two patients out of these four died.In contrast, there were no intraoperative complications or deaths in the 2nd group. In addition, the algorithm allowed the removal of 18% more lymph nodes, reduction in the incidence of postoperative pneumonia by 25%, the operation time by 25±15 minutes, and the length of stays by 3±2 days, compared with the 1st group of patients. ConclusionTopographic anatomical navigation can reduce the incidence of intra- and postoperative complications, effectively guide lymph node dissection, and shorten hospital stay.

Purpose There is no systematic description of primary anatomical landmarks that allow a surgeon to reliably and safely navigate the superior and posterior mediastinum’s fat tissue spaces near large vessels and nerves during video-assisted endothoracoscopic interventions in the prone position of a patient. Our aim was to develop an algorithm of sequential visual navigation during thoracoscopic extirpation of the esophagus and determine the most permanent topographic and anatomical landmarks allowing safe thoracoscopic dissection of the esophagus in the prone position. Methods The anatomical study of the mediastinal structural features was carried out on 30 human cadavers before and after opening the right pleural cavity. Results For thoracoscopic extirpation of the esophagus in the prone position, anatomical landmarks are defined, their variants are assessed, and an algorithm for their selection is developed, allowing their direct visualization before and after opening the mediastinal pleura. Conclusion The proposed algorithm for topographic and anatomical navigation based on the key anatomical landmarks in the posterior mediastinum provides safe performance of the video-assisted thoracoscopic extirpation of the esophagus in the prone position.