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Fu J, Li Y, Wang Z, Cheng Y, Chen N, Sun X, Zhang B, Peng Z, Chen W, Qian R, Shi A, Yan X, Wang H, Ma F, Lv Y, Zhang Y. The role of magnetic anchoring and traction technique in thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve. Surg Endosc 2022; 36:3653-3662. [PMID: 35080676 DOI: 10.1007/s00464-022-09052-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/11/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Dissecting lymph nodes along the left recurrent laryngeal nerve (LRLN) is the most challenging step in thoracoscopic-assisted esophagectomy. To retract the proximal esophagus in the existing lymphadenectomy methods, either a special trocar is required to insert and take out endoscopic instruments or thoracic punctures are needed to externally retract the esophageal loop. Therefore, advanced skills for esophageal traction are important to facilitate the LRLN lymphadenectomy and to reduce the incidence of trauma to the chest wall. Herein, we present the magnetic anchoring and traction technique, a novel method for LRLN lymphadenectomy during thoracoscopic esophagectomy. METHODS The magnetic anchoring traction system was successfully used to retract the upper thoracic esophagus and to help expose the upper mediastinum in 10 cases of thoracoscopic-assisted esophagectomy. When the external magnet was moved outside of body, the internal magnet was coupled with a magnetic force to pull the proximal esophagus to the appropriate direction, which helped to expose the LRLN and adjacent lymph nodes. The lymph nodes adjacent to the LRLN could then be dissected completely without any damage to the nerve. RESULTS In all surgeries, the LRLN and adjacent lymph nodes were well visualized, and the number of trocars used to pass endoscopic instruments for retraction of the proximal esophagus or the number of thoracic punctures for external traction of the esophagus during the surgery were reduced. CONCLUSIONS In thoracoscopic-assisted esophagectomy, the magnetic anchoring and traction technique can improve the exposure of the LRLN, facilitate LRLN lymphadenectomy, and reduce chest wall trauma.
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Affiliation(s)
- Junke Fu
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yunhao Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Ziwei Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yuan Cheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Nanzheng Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xin Sun
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Boxiang Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Ziyang Peng
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Wenwen Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Rongkai Qian
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Aihua Shi
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaopeng Yan
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Haohua Wang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Feng Ma
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yong Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Zhang SF, Zhou GH, Cai HB. Tumor length-to-height ratio as a predictor of recurrent laryngeal nerve lymph node metastasis in patients with thoracic esophageal squamous cell carcinoma. MINERVA CHIR 2020; 75:266-271. [PMID: 32456390 DOI: 10.23736/s0026-4733.20.08246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The metastasis of laryngeal nerve lymph node is mostly found in the upper-and middle esophageal cancer, the ratio of esophageal length from the upper incisors to the position where the esophageal tumor began to appear as proven via endoscopy to the height (LH) is likely to affect the possibility of detection of recurrent laryngeal nerve(RLN) lymph node (LN) metastasis. The purpose of this study was to evaluate the predictive value of LH for RLN LN metastasis. METHODS One hundred and eighty-eight patients (mean age: 64.89 years; range: 46-84 years) calculated LH before esophagectomy and LN dissection were retrospective analyzed. The clinicopathological data of the patients, LH calculations were compared with the RLN LN histopathologic results to investigate the effect of LH on the diagnosis of RLN LN metastasis. RESULTS The LH correlated with that of the RLN LN metastasis in receiver-operating-characteristic (ROC) analysis. Our ROC analyses demonstrated the optimal cut-off value was 16.66 for LH with an area under the curve value of 0.69. Compared with the Height (H) and L, ROC curve for LH have better performance in predicting the RLN LN metastasis. CONCLUSIONS LH is a useful predictive tool in the evaluation of RLN LN metastasis for esophageal cancer. The present findings support the result that LH can be an indicator of RLN LN dissection.
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Affiliation(s)
- Shi-Fa Zhang
- Department of Thoracic Surgery, Jining No.1 Hospital, Jining, China -
| | - Guang-Hua Zhou
- Department of Thoracic Surgery, Jining No.1 Hospital, Jining, China
| | - Hai-Bo Cai
- Department of Thoracic Surgery, Jining No.1 Hospital, Jining, China
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Zhang Z, Rong B, Guo M, Xu M. Application of esophageal wire traction in lymph node dissection during three-hole thoracoscopic McKeown esophagectomy. MINIM INVASIV THER 2020; 30:202-207. [PMID: 32091290 DOI: 10.1080/13645706.2020.1732425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The quality of left recurrent laryngeal nerve lymph node dissection is critical in esophageal cancer. We investigated whether esophageal wire traction in three-hole thoracoscopic esophagectomy can improve the same. MATERIAL AND METHODS We retrospectively analyzed the data of 98 patients who underwent thoracoscopic esophagectomy in our center from January 2018 to July 2018: 36 patients with esophageal wire traction and 62 patients without traction (control group). The clearance time for left recurrent laryngeal nerve lymph nodes, thoracic bleeding volume, number of left recurrent laryngeal nerve lymph nodes, and complications were recorded. RESULTS The observation group had a shorter clearance time for the left recurrent laryngeal nerve lymph nodes (15.8 ± 6.9 min vs. 20.00 ± 6.2 min), less thoracic bleeding (55.8 ± 30.2 mL vs. 70.7 ± 30.3 mL), and higher number of dissected left recurrent laryngeal lymph nodes (3.3 ± 1.4 vs. 2.5 ± 1.1) than the control group. There was no significant difference in the incidence of anastomotic leakage, pulmonary infection, arrhythmia, chylothorax, and nerve injury. CONCLUSIONS Esophageal wire traction shortens the clearance time for the left recurrent laryngeal nerve lymph nodes, reduces thoracic bleeding, and improves the quality of left recurrent laryngeal nerve lymph node dissection in three-hole thoracoscopic esophagectomy.
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Affiliation(s)
- Zhenghua Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, China
| | - Baolin Rong
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, China
| | - Mingfa Guo
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, China
| | - Meiqing Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, China
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Cuesta MA. Review of different approaches of the left recurrent laryngeal nerve area for lymphadenectomy during minimally invasive esophagectomy. J Thorac Dis 2019; 11:S766-S770. [PMID: 31080656 DOI: 10.21037/jtd.2018.12.52] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In order to perform the total mediastinal lymphadenectomy during minimally invasive esophageal resection, doing the lymphadenectomy along the left recurrent laryngeal nerve (LRLN) may be a difficult part of this intervention. One reason is the need for the correct visualization of the area; another is not wanting to compromise the integrity of the nerve. In this review article the different modalities for approaching this upper mediastinal area by thoracoscopy are described.
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Affiliation(s)
- Miguel A Cuesta
- Gastrointestinal and Minimally Invasive Surgery, VUmc Medical Center, Amsterdam, The Netherlands
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Abstract
Based in the anatomical concept of the mesoesophagus, that at subcarinal level all the vessels come through a by-layer connective tissue plane from the aorta to the esophagus whereas supracarinally these structures will come from both sides, with vagal and recurrent laryngeal nerves, a minimally invasive mesoesophageal (MIME) resection model may be described. Based on this surgical plane concept, dissection of esophagus and mediastinal lymphadenectomy can be performed along these structures establishing clear anatomical modules for an adequate oncological resection.
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Affiliation(s)
- Miguel A Cuesta
- Emeritus professor Gastrointestinal Surgery and Minimally Invasive Surgery, Vumc Medical Center, Amsterdam, The Netherlands
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