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Open Access 01-04-2017

Surgical anatomy of the supracarinal esophagus based on a minimally invasive approach: vascular and nervous anatomy and technical steps to resection and lymphadenectomy

Authors: Miguel A. Cuesta, Nicole van der Wielen, Teus J. Weijs, Ronald L. A. W. Bleys, Suzanne S. Gisbertz, Peter van Duijvendijk, Richard van Hillegersberg, Jelle P. Ruurda, Mark I. van Berge Henegouwen, Jennifer Straatman, Harushi Osugi, Donald L. van der Peet

Published in: Surgical Endoscopy | Issue 4/2017

Abstract

Background

During esophageal dissection and lymphadenectomy of the upper mediastinum by thoracoscopy in prone position, we observed a complex anatomy in which we had to resect the esophagus, dissect vessels and nerves, and take down some of these in order to perform a complete lymphadenectomy. In order to improve the quality of the dissection and standardization of the procedure, we describe the surgical anatomy and steps involved in this procedure.

Methods

We retrospectively evaluated twenty consecutive and unedited videos of thoracoscopic esophageal resections. We recorded the vascular anatomy of the supracarinal esophagus, lymph node stations and the steps taken in this procedure. The resulting concept was validated in a prospective study including five patients.

Results

Seventy percent of patients in the retrospective study had one right bronchial artery (RBA) and two left bronchial arteries (LBA). The RBA was divided at both sides of the esophagus in 18 patients, with preservation of one LBA or at least one esophageal branch in all cases. Both recurrent laryngeal nerves were identified in 18 patients. All patients in the prospective study had one RBA and two LBA, and in four patients the RBA was divided at both sides of the esophagus and preserved one of the LBA. Lymphadenectomy was performed of stations 4R, 4L, 2R and 2L, with a median of 11 resected lymph nodes. Both recurrent laryngeal nerves were identified in four patients. In three patients, only the left recurrent nerve could be identified. Two patients showed palsy of the left recurrent laryngeal nerve, and one showed neuropraxia of the left vocal cord.

Conclusions

Knowledge of the surgical anatomy of the upper mediastinum and its anatomical variations is important for standardization of an adequate esophageal resection and paratracheal lymphadenectomy with preservation of any vascularization of the trachea, bronchi and the recurrent laryngeal nerves.

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Title: Surgical anatomy of the supracarinal esophagus based on a minimally invasive approach: vascular and nervous anatomy and technical steps to resection and lymphadenectomy
Authors: Miguel A. Cuesta
Nicole van der Wielen
Teus J. Weijs
Ronald L. A. W. Bleys
Suzanne S. Gisbertz
Peter van Duijvendijk
Richard van Hillegersberg
Jelle P. Ruurda
Mark I. van Berge Henegouwen
Jennifer Straatman
Harushi Osugi
Donald L. van der Peet
Publication date: 01-04-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5186-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Surgical anatomy of the supracarinal esophagus based on a minimally invasive approach: vascular and nervous anatomy and technical steps to resection and lymphadenectomy

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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