Technical details of video‐assisted transcervical mediastinal dissection for esophageal cancer and its perioperative outcome

Abstract

To reduce pulmonary complications after esophagectomy, the transthoracic procedure should be shortened or totally avoided. Transcervical approach assisted by mediastinoscope for the upper mediastinum may be advantageous for this purpose. We carried out video‐assisted transcervical mediastinal dissection (VATCMD) as part of totally non‐transthoracic radical esophagectomy. A single‐port laparoscopy device was adopted to a small cervical incision and the mediastinum was inflated with a positive pressure of 6 to 10 mmHg. Without assistant's retractor, the upper mediastinum and partially the middle mediastinum were dissected mainly by mediastinoscopic‐assisted surgery. Video of the operation is demonstrated with illustrations. We have carried out and reported 17 cases of esophagectomy including VATCMD and its perioperative outcome. Non‐transthoracic esophagectomy was completed without conversion to transthoracic procedure in all 17 cases. Procedure‐related adverse event was not observed and postoperative course was favorable with a zero occurrence (0%) of recurrent laryngeal nerve palsy, chyle leakage or pulmonary complications. Median number of harvested lymph nodes from the upper mediastinal stations was 10. VATCMD is suggested as a safe and feasible approach for the upper mediastinum in esophagectomy for malignancies. It enabled a totally non‐transthoracic radical esophagectomy in combination with a transhiatal approach.Video‐assisted transcervical mediastinal dissection is suggested as a safe and feasible approach for the upper mediastinum in esophagectomy for malignancies. It enabled a totally non‐transthoracic radical esophagectomy in combination with a transhiatal approach.

Recent advances in thoracoscopic esophagectomy for esophageal cancer

“…Recently, Mori et al and Nakauchi et al reported robot-assisted non-thoracic radical esophagectomy for esophageal cancer, including mediastinal lymphadenectomy via a transcervical approach (18,19). This procedure was confirmed to be technically feasible and safe, and potentially offers a useful surgical option for esophageal cancer (18).…”

“…Mediastinoscopy-assisted transhiatal esophagectomy is a minimally invasive option for thoracic esophageal cancer that potentially reduces pulmonary complications by avoiding one-lung ventilation or transthoracic procedures (17). Recently, Mori et al and Nakauchi et al reported robot-assisted non-thoracic radical esophagectomy for esophageal cancer, including mediastinal lymphadenectomy via a transcervical approach (18,19). This procedure was confirmed to be technically feasible and safe, and potentially offers a useful surgical option for esophageal cancer (18).…”

Transmediastinal approach for esophageal cancer: A new trend toward radical surgery

“…In addition, subcarinal and main bronchial lymphadenectomy, the most difficult procedure when using the transhiatal approach alone, can be much more readily achieved in combination with the transcervical procedure . More recently, Mori et al also adopted the same left cervical approach using a single‐port mediastinoscopy and reported the technical details in relation to transcervical surgical anatomy . For a surgeon to perform TME safely, preoperative 3‐D CT and 3‐D CT angiography of the bronchial arteries are useful for simulating the transmediastinal surgical anatomy and for reducing the risk of mediastinal bleeding (Figure ) .…”

Current status of minimally invasive esophagectomy for esophageal cancer: Is it truly less invasive?

“…They concluded that MATHE developed with the single‐port mediastinoscopic transcervical technique is feasible in terms of perioperative outcomes for a radical surgery to treat thoracic esophageal cancer, although its safety needs to be further investigated . Mori et al also carried out transcervical mediastinoscopic lymphadenectomy as part of totally non‐transthoracic radical esophagectomy for 17 patients in which the upper mediastinum and part of the middle mediastinum are dissected mainly with mediastinoscopic‐assisted surgery. There were no conversions to transthoracic procedure.…”

“…Median number of harvested lymph nodes from the upper mediastinal stations was 10. The authors concluded that transcervical mediastinoscopic lymphadenectomy is a safe and feasible procedure that enabled total non‐transthoracic radical esophagectomy in combination with a transhiatal approach …”