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01-03-2017 | New Technology

A new method (the “Pincers maneuver”) for lymphadenectomy along the right recurrent laryngeal nerve during thoracoscopic esophagectomy in the prone position for esophageal cancer

Authors: Taro Oshikiri, Tetsu Nakamura, Yukiko Miura, Masashi Yamamoto, Shingo Kanaji, Kimihiro Yamashita, Takeru Matsuda, Yasuo Sumi, Satoshi Suzuki, Yoshihiro Kakeji

Published in: Surgical Endoscopy | Issue 3/2017

Abstract

Background

In esophageal squamous cell carcinoma, the number of dissected lymph nodes (LNs), including those along the recurrent laryngeal nerves (RLNs), influences prognosis and nodal staging accuracy. However, dissection of LNs along the RLN increases the risk of complications, especially RLN palsy. Therefore, complete dissection of these LNs with prevention of RLN palsy is recommended. We present herein a new method for lymphadenectomy along the right RLN, named the Pincers maneuver, during thoracoscopic esophagectomy in the prone position (TEP).

Methods

The fundamental concept in this new method is to first exfoliate the two-dimensional membrane (lateral pedicle), which includes the right RLN, LNs along the right RLN, and the primary esophageal artery, from the right side of the trachea toward the neck. Using a Pincers strategy, closing in from the inner and outer sides of the two-dimensional membrane (lateral pedicle), lymphadenectomy along the right RLN toward the right inferior thyroid artery should be easy. This technique was evaluated in 30 consecutive cases of TEP for squamous cell cancer.

Results

There were 15 patients who underwent the new method (Pincers maneuver; Pm) and 15 patients who underwent the conventional method (Cm). There were no significant differences between the two groups in the duration of the thoracic procedure and dissection along the right RLN. No intraoperative and postoperative morbidity related to the right RLN was observed in either group. The Pm group had a higher number of dissected LNs along the right RLN than the Cm group (6.3 vs 3.1, p = 0.044).

Conclusions

The Pincers maneuver for lymphadenectomy along the right RLN during TEP is technically safe and feasible. It increases the number of dissected LNs along the right RLN.

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Title: A new method (the “Pincers maneuver”) for lymphadenectomy along the right recurrent laryngeal nerve during thoracoscopic esophagectomy in the prone position for esophageal cancer
Authors: Taro Oshikiri
Tetsu Nakamura
Yukiko Miura
Masashi Yamamoto
Shingo Kanaji
Kimihiro Yamashita
Takeru Matsuda
Yasuo Sumi
Satoshi Suzuki
Yoshihiro Kakeji
Publication date: 01-03-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 3/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5124-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A new method (the “Pincers maneuver”) for lymphadenectomy along the right recurrent laryngeal nerve during thoracoscopic esophagectomy in the prone position for esophageal cancer

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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