Effective Mediastinal Lymphadenectomy for Esophageal Cancer Using Slender Tracheal Forceps in Prone Position Thoracoscopic Esophagectomy.
OBJECTIVE
Adequate mediastinal lymphadenectomy during thoracoscopic esophagectomy (TE) requires an extensive operating field. In order to rectify this problem, we developed slender tracheal forceps that can pass through a 12-mm trocar.


METHODS
TE in the prone position was performed in 58 patients with esophageal cancer using slender tracheal forceps. Perioperative and postoperative clinical data were compared against those of 61 patients who underwent transthoracic open esophagectomy (OE).


RESULTS
The mean duration of thoracic manipulation was significantly longer in the TE than OE group: 226.2 versus 171.3 minutes (p<0.0001). Mean blood loss was significantly lower in the TE than OE group: 39.9 versus 176.8 g (p<0.0001). A mean of 23.4 mediastinal lymph nodes were dissected in the TE group and 25.1 in the OE group. The timing of extubation tended to be earlier in the TE group. Postoperative morbidity did not differ between groups.


CONCLUSIONS
Slender tracheal forceps are acceptable for fine mediastinal lymphadenectomy in thoracoscopic surgery for esophageal cancer, and the technique could contribute to development of minimally invasive surgery.
Department of Surgery I, Dokkyo Medical University, Mibu, Japan mnakajim@dokkyomed.ac.jp.
Masanobu
M
Nakajima
Department of Surgery I, Dokkyo Medical University, Mibu, Japan.
Masakazu
M
Takahashi
Department of Surgery I, Dokkyo Medical University, Mibu, Japan.
Yasushi
Y
Domeki
Department of Surgery I, Dokkyo Medical University, Mibu, Japan.
Hitoshi
H
Satomura
Department of Surgery I, Dokkyo Medical University, Mibu, Japan.
Hiroto
H
Muroi
Department of Surgery I, Dokkyo Medical University, Mibu, Japan.
Maiko
M
Kikuchi
Department of Surgery I, Dokkyo Medical University, Mibu, Japan.
Hideo
H
Ogata
Department of Surgery I, Dokkyo Medical University, Mibu, Japan.
Satoru
S
Yamaguchi
Department of Surgery I, Dokkyo Medical University, Mibu, Japan.
Kinro
K
Sasaki
Department of General Surgical Science (Surgery I), Gunma University, Graduate School of Medicine, Maebashi, Japan.
Makoto
M
Sakai
Department of General Surgical Science (Surgery I), Gunma University, Graduate School of Medicine, Maebashi, Japan.
Makoto
M
Sohda
Department of General Surgical Science (Surgery I), Gunma University, Graduate School of Medicine, Maebashi, Japan.
Tatsuya
T
Miyazaki
Department of General Surgical Science (Surgery I), Gunma University, Graduate School of Medicine, Maebashi, Japan.
Hiroyuki
H
Kuwano
Department of Surgery I, Dokkyo Medical University, Mibu, Japan.
Hiroyuki
H
Kato
D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008482:Mediastinum / Q000601:surgery; D008875:Middle Aged; D016684:Prone Position; D013906:Thoracoscopy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
Esophageal cancer; lymphadenectomy; minimal invasive surgery; prone position; thoracoscopic esophagectomy