title: Reliable Surgical Techniques for Lymphadenectomy Along the Left Recurrent Laryngeal Nerve During Thoracoscopic Esophagectomy in the Prone Position.
abstract: BACKGROUND
  Lymphadenectomy along the left recurrent laryngeal nerve (RLN) in esophageal cancer is important for disease control1but requires advanced dissection skills. We previously reported a reliable method2for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the prone position (TEP). The goal of this method is complete dissection of the lymph nodes along the left RLN in a safe manner.
  
  
  METHODS
  This procedure is performed for all resectable thoracic esophageal cancers. The essence of the method is to recognize the lateral pedicle as a two-dimensional membrane that includes the left RLN, lymph nodes, and primary esophageal arteries. By drawing the proximal portion of the divided esophagus and the lateral pedicle, identification and reliable cutting of the primary esophageal arteries, as well as distinguishing the left RLN from the lymph nodes, becomes simplified.
  
  
  RESULTS
  We performed 46 TEPs using this method, with no conversion to an open procedure, at Kobe University in 2015. The body mass index of these patients was distributed between 19 and 32, and the mean number of harvested lymph nodes along the left RLN was 6.9 ± 4.2. Left RLN palsy greater than Clavien-Dindo classification grade II occurred in four patients (8% )without permanent paralysis, while the incidence of lymph node metastasis along the left RLN was 22%.
  
  
  CONCLUSIONS
  Our method for lymphadenectomy along the left RLN during TEP is safe and reliable. It has a low incidence of left RLN palsy and provides sufficient lymph node dissection along the left RLN.
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan. oshikiri@med.kobe-u.ac.jp.
authors.forename: Taro
authors.initials: T
authors.lastname: Oshikiri
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hasegawa
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Kanaji
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Kimihiro
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Takeru
authors.initials: T
authors.lastname: Matsuda
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sumi
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
mesh_terms: D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D006801:Humans; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods*; D056888:Patient Positioning; D011183:Postoperative Complications / Q000209:etiology*; D016684:Prone Position; D012009:Recurrent Laryngeal Nerve; D013906:Thoracoscopy / Q000379:methods; D013909:Thorax; D014826:Vocal Cord Paralysis / Q000209:etiology*