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

AbstractBACKGROUND:
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.
AuthorsTaro Oshikiri, Takashi Yasuda, Hitoshi Harada, Hironobu Goto, Masato Oyama, Hiroshi Hasegawa, Tadayuki Ohara, Hiroyoshi Sendo, Tetsu Nakamura, Yasuhiro Fujino, Masahiro Tominaga, Yoshihiro Kakeji
JournalSurgical endoscopy (Surg Endosc) Vol. 29 Issue 8 Pg. 2442-50 (Aug 2015) ISSN: 1432-2218 [Electronic] Germany
PMID25303923 (Publication Type: Comparative Study, Journal Article)
Topics
  • Aged
  • Blood Loss, Surgical
  • Carcinoma, Squamous Cell (surgery)
  • Esophageal Neoplasms (surgery)
  • Esophagectomy
  • Esophagoscopy
  • Female
  • Hoarseness (etiology)
  • Humans
  • Lymph Node Excision (methods)
  • Male
  • Operative Time
  • Postoperative Complications
  • Prone Position
  • Recurrent Laryngeal Nerve Injuries (prevention & control)
  • Retrospective Studies

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