Histological study of the thin membranous structure made of dense connective tissue around the esophagus in the upper mediastinum

Tokairin, Yutaka; Nakajima, Yasuaki; Kawada, Kenro; Hoshino, Akihiro; Okada, Takuya; Ryotokuji, Tairo; Okuda, Masafumi; Kume, Yuichiro; Kawamura, Yudai; Yamaguchi, Kazuya; Nagai, Kagami; Akita, Keiichi; Kinugasa, Yusuke

doi:10.1007/s10388-018-0625-9

Cited by 20 publications

(9 citation statements)

References 11 publications

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“…In the early phase of introducing TEPP in this decade, there were some reports about its conferred advantages for lymph node dissection, especially in the upper mediastinum [9][10][11][12] . Along with the recent, remarkable progress of endoscopic optical instruments such as 3D and 4K ultra-HD, there have also been reports about the microanatomy-based surgical concept for MIE, similar to total meso-rectal excision in rectal cancer surgery [13][14][15][16][17][18] . More recently, we have established the microanatomy-based standardization using the concept of the meso-esophagus wrapped with the visceral and vascular sheaths and reported χ 2 test.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, progress in the development of endoscopic optical instruments [2K full highdefinition (HD), 4K ultra-HD, and 3-dimensional] has been remarkable. Using them, we have been able to identify the fine microanatomy of membranes and layers that were not previously visualized, and there have been some reports on this new concept of surgical microanatomy and its usefulness in esophageal cancer surgery [13][14][15][16][17][18] .…”

Section: Introductionmentioning

confidence: 99%

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Standardization of bilateral upper mediastinal lymph node dissection using microanatomical concepts in minimally invasive esophagectomy

Shirakawa¹,

Noma²,

Maeda³

et al. 2020

MIS

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Aim:We have recently standardized upper mediastinal lymph node dissection (UMLND) based on microanatomical concepts in minimally invasive esophagectomy using a 4K ultra-high-definition (HD) system. In this study, the aim was to investigate the outcomes of microanatomy-based standardization using 4K ultra-HD for UMLND with the main focus on thoracoscopic operative time. Methods:We have performed more than 500 cases of thoracoscopic esophagectomy in the prone position as minimally invasive esophagectomy. After about 400 cases of thoracoscopic esophagectomy in the prone position, we established the microanatomy-based standardization of UMLND using a 4K ultra-HD system. Two groups were analyzed: a pre-standardization group (n = 100) and a post-standardization group (n = 100). Furthermore, the change in our thoracoscopic operative time for all cases was analyzed using the moving average method.Results: In the post-standardization group, the rate of surgeries performed by operators with less than 20 years' experience was significantly higher (P < 0.001). There were no significant differences in the number of mediastinal lymph nodes dissected, intraoperative blood loss and total postoperative morbidity rates between the two groups. The rate of recurrent laryngeal nerve palsy decreased to less than half (19.8% to 9.6%) (P = 0.061) and the thoracoscopic operative time decreased [232.0 (202.8-264.0) min to 209.0 (176.0-235.0) min] significantly (P < 0.001) after standardization. The moving average showed a marked decrease of thoracoscopic operative time during the standardization phase. Conclusion:Microanatomy-based standardization enabled quicker and more precise UMLD despite an increase in the number of surgeries performed by less experienced operators.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Standardization of bilateral upper mediastinal lymph node dissection using microanatomical concepts in minimally invasive esophagectomy

Shirakawa¹,

Noma²,

Maeda³

et al. 2020

MIS

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“…[21][22][23][24] Furthermore, a new laparoscope with 3D and 4K ultra-HD technologies enhanced optical visualization during MIE, which allowed surgeons to apply microanatomy-based surgical concepts for dissection, including visceral sheath and mesoesophagus for MIE. [25][26][27][28][29] Recently, around 2500 cases of thoracoscopic esophagectomies were performed annually in Japan, amounting to 40% of the total number of esophageal cancer surgeries, and 60% of these thoracoscopic esophagectomies were performed in the prone position.…”

Section: The Concept Of Mie In Japanmentioning

confidence: 99%

Recent advances in minimally invasive esophagectomy for squamous esophageal cancer

Yip

Shirakawa

Cheng

et al. 2020

Annals of the New York Academy of Sciences

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Over the past decade there has been tremendous development in the clinical application of minimally invasive esophagectomy (MIE) for the treatment of squamous esophageal carcinoma. The major challenges in the performance of MIE include limitations in visualization and manipulation within the confined, rigid thoracic cavity; the need for adequate patient positioning and anesthetic techniques to accommodate the surgical exposure; and changes in the surgical steps for achieving radical nodal dissection, especially for the superior mediastinum. The surgical procedure for MIE is more and more standardized, and there is an increasing practice of MIE worldwide. Randomized trials and meta-analyses have confirmed the advantages of MIE over open esophagectomy, including a significantly lower rate of complications and shorter hospital stays. The recent application of robotics technologies for MIE has further enhanced the quality and safety of the surgical dissection, while intraoperative nerve monitoring has contributed to a lower rate of recurrent laryngeal nerve palsy. With the application of new technologies, we expect further improvement in surgical outcomes for MIE in the treatment of squamous esophageal cancer.

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“…Several concepts regarding the membranous structures in the upper mediastinum, such as the visceral sheath and mesotracheoesophagus, have been reported. 2,3 Oshikiri et al 4 described a procedure for dissecting the LNs along the left recurrent laryngeal nerve by minimally invasive esophagectomy (MIE) and termed this the 'Bascule method'. After mobilizing the upper esophagus from the trachea by cutting the tracheal arteries and then mobilizing the tissue together with the left recurrent laryngeal nerve and LNs from the trachea, the so-called ''esophageal mesenteriolum' can be recognized.…”

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confidence: 99%

Further Consideration of Lymphadenectomy Along the Left Recurrent Laryngeal Nerve During Robot-Assisted Minimally Invasive Esophagectomy

et al. 2021

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Histological study of the thin membranous structure made of dense connective tissue around the esophagus in the upper mediastinum

Abstract: The "visceral sheath" around the esophagus in the upper mediastinum was histologically demonstrated; however, the findings were not constant.

Cited by 20 publications

References 11 publications

Standardization of bilateral upper mediastinal lymph node dissection using microanatomical concepts in minimally invasive esophagectomy

Standardization of bilateral upper mediastinal lymph node dissection using microanatomical concepts in minimally invasive esophagectomy

Recent advances in minimally invasive esophagectomy for squamous esophageal cancer

Further Consideration of Lymphadenectomy Along the Left Recurrent Laryngeal Nerve During Robot-Assisted Minimally Invasive Esophagectomy

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