title: A novel method for lymphadenectomy along the left laryngeal recurrent nerve during thoracoscopic esophagectomy for esophageal carcinoma.
abstract: BACKGROUND
  Due to limited space in the left upper mediastinum, complete dissection of lymph nodes (LN) along left recurrent laryngeal nerve (RLN) is difficult. We herein present a novel method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position for esophageal carcinoma. The method, suspension the esophagus and push aside trachea, allows en bloc lymphadenectomy along the left RLN from the below aortic arch to the thoracic inlet.
  
  
  METHODS
  Between September 2014 and September 2015, a total of 110 consecutive patients with esophageal carcinoma were treated with thoraco-laparoscopic esophagectomy with cervical anastomosis in the semi-prone position. Outcomes between those who received surgery with the novel method and conventional surgery were compared.
  
  
  RESULTS
  Fifty patients underwent the novel method and sixty received conventional surgery. The operative field around the left RLN was easier to explore with the novel method. The estimated blood loss was less (23.7±8.2 vs. 34.2±10.3 g, P=0.001), and the number of harvested LNs along the left RLN was greater (6.4±3.2 vs. 4.1±2.8 min, P=0.028) in the novel method group, while the duration of lymphadenectomy along left RLN was longer in the novel method group (28.2±3.9 vs. 20.3±2.8 min, P=0.005). The rate of hoarseness in the novel and conventional groups was 10% and 16.7%, respectively. No significant difference in postoperative morbidity related to the left RLN was noted between the groups.
  
  
  CONCLUSIONS
  The novel method during semi-prone esophagectomy for esophageal carcinoma is associated with better surgeon ergonomics and operative exposure.
authors.affiliation: 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Thoracic Surgery, People's Hospital of Yangzhong, Yangzhong 212200, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Xi
authors.affiliation: 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Thoracic Surgery, People's Hospital of Yangzhong, Yangzhong 212200, China.
authors.forename: Zhenkai
authors.initials: Z
authors.lastname: Ma
authors.affiliation: 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Thoracic Surgery, People's Hospital of Yangzhong, Yangzhong 212200, China.
authors.forename: Yaxing
authors.initials: Y
authors.lastname: Shen
authors.affiliation: 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Thoracic Surgery, People's Hospital of Yangzhong, Yangzhong 212200, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Thoracic Surgery, People's Hospital of Yangzhong, Yangzhong 212200, China.
authors.forename: Mingxiang
authors.initials: M
authors.lastname: Feng
authors.affiliation: 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Thoracic Surgery, People's Hospital of Yangzhong, Yangzhong 212200, China.
authors.forename: Lijie
authors.initials: L
authors.lastname: Tan
authors.affiliation: 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Thoracic Surgery, People's Hospital of Yangzhong, Yangzhong 212200, China.
authors.forename: Qun
authors.initials: Q
authors.lastname: Wang
keywords: Semi-prone esophagectomy; esophageal carcinoma; left recurrent laryngeal nerve (RLN); lymphadenectomy; novel method