title: Dissection with a metal dissector: a useful adjunct to transhiatal oesophagectomy.
abstract: OBJECTIVE
  Intraoperative cardiovascular instability is frequently observed during blunt finger dissection for transhiatal oesophagectomy. We conducted a prospective study using a metal ring dissector for blunt dissection of the oesophagus to overcome this problem.
  
  
  METHODS
  Dissection with a metal ring dissector was used in 30 consecutive patients undergoing transhiatal oesophagectomy for carcinoma of the lower oesophagus (n=26) and oesophagogastric junction (n=4).
  
  
  RESULTS
  Dissection of the oesophagus proximal to the growth was quick and straightforward in all instances. The procedure appeared less traumatic than the conventional manual technique and was not associated with any intraoperative cardiovascular instability or intramediastinal bleeding. None of the patients had tracheal injury or recurrent laryngeal nerve paralysis. There was one anastomotic leak and no deaths.
  
  
  CONCLUSIONS
  Oesophageal blunt dissection with a metal ring dissector is safe, easy and quick. The correct plane of dissection minimizes the risk of intramediastinal bleeding and inadvertent trauma to neighbouring structures.
authors.affiliation: GI Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, India. dhanshar@hotmail.com
authors.forename: Dhananjaya
authors.initials: D
authors.lastname: Sharma
authors.forename: Sunil
authors.initials: S
authors.lastname: Agrawal
authors.forename: Arjun
authors.initials: A
authors.lastname: Saxena
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control; D004210:Dissection / Q000295:instrumentation*; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008875:Middle Aged; D011446:Prospective Studies