title: A new method (the "Bascule method") for lymphadenectomy along the left recurrent laryngeal nerve during prone esophagectomy for esophageal cancer.
abstract: BACKGROUND
  In esophageal cancer, lymph nodes along the recurrent laryngeal nerves (RLNs) are thought to be highly involved. Complete dissection of these lymph nodes is recommended but there is limited working space in the left upper mediastinum and advanced dissection skills are required. We present herein a new method for lymphadenectomy along the left RLN, called the Bascule method during prone esophagectomy.
  
  
  METHODS
  The fundamental concept of this new method is to draw the proximal portion of the divided esophagus and tissue that includes the left RLN and lymph nodes through a gap between the vertebral body and the right scapula. Using this technique, a two-dimensional membrane, similar to the "esophageal mesenteriolum" (lateral pedicle), will be easily recognizable. Identification and reliable cutting of the tracheoesophageal artery and distinguishing the left RLN from the lymph nodes should be easy. This technique was evaluated in 39 consecutive cases of prone esophagectomy for squamous cell cancer.
  
  
  RESULTS
  There were 18 patients who underwent the new method (Bascule method; Bm) and 21 patients who underwent the conventional method (Cm). The duration of the thoracic procedure and dissection along the left RLN was significantly shorter in Bm group than in Cm group (258 ± 30 vs. 291 ± 39 min; p = 0.007 and 66 ± 9 vs. 75 ± 14 min; p = 0.036, respectively). Estimated blood loss in Bm group was 20 ± 11 g compared to 38 ± 32 g in Cm group (p = 0.028). No intraoperative morbidity related to the left RLN was observed in either group. The hoarseness rate in Bm group was 28 %, which was lower than that in the Cm group (48 %).
  
  
  CONCLUSIONS
  The Bascule method for lymphadenectomy along the left RLN during prone esophagectomy is technically safe and feasible and reduces operative time and blood loss.
authors.affiliation: Department of Gastroenterological Surgery, Hyogo Cancer Center, 13-70, kitaoji-cho, Akashi, Hyogo, 673-8558, Japan, taro_oshikiri@hp.pref.hyogo.jp.
authors.forename: Taro
authors.initials: T
authors.lastname: Oshikiri
authors.forename: Takashi
authors.initials: T
authors.lastname: Yasuda
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Harada
authors.forename: Hironobu
authors.initials: H
authors.lastname: Goto
authors.forename: Masato
authors.initials: M
authors.lastname: Oyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Ohara
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Sendo
authors.forename: Tetsu
authors.initials: T
authors.lastname: Nakamura
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujino
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tominaga
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D004945:Esophagoscopy; D005260:Female; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications; D016684:Prone Position; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control*; D012189:Retrospective Studies