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Surgical Endoscopy
Published in: Surgical Endoscopy 8/2015

01-08-2015 | Technique

A new method (the “Bascule method”) for lymphadenectomy along the left recurrent laryngeal nerve during prone esophagectomy for esophageal cancer

Authors: Taro Oshikiri, Takashi Yasuda, Hitoshi Harada, Hironobu Goto, Masato Oyama, Hiroshi Hasegawa, Tadayuki Ohara, Hiroyoshi Sendo, Tetsu Nakamura, Yasuhiro Fujino, Masahiro Tominaga, Yoshihiro Kakeji

Published in: Surgical Endoscopy | Issue 8/2015

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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.
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Metadata
Title
A new method (the “Bascule method”) for lymphadenectomy along the left recurrent laryngeal nerve during prone esophagectomy for esophageal cancer
Authors
Taro Oshikiri
Takashi Yasuda
Hitoshi Harada
Hironobu Goto
Masato Oyama
Hiroshi Hasegawa
Tadayuki Ohara
Hiroyoshi Sendo
Tetsu Nakamura
Yasuhiro Fujino
Masahiro Tominaga
Yoshihiro Kakeji
Publication date
01-08-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 8/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3919-6

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