-Case Reports-

Esophageal Stripping Creates a Clear Operative Field for Lymph Node Dissection along the Left Recurrent Laryngeal Nerve in Prone Video-Assisted Thoracoscopic Surgery

Hiroshi Makino, Tsutomu Nomura, Masao Miyashita, Keiichi Okawa, Nobutoshi Hagiwara and Eiji Uchida

Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
Department of Surgery, Nippon Medical School

We describe a 54-year-old man in whom esophageal carcinoma was diagnosed and who underwent video-assisted thoracoscopic surgery of the esophagus (VATS-E) in the prone position. Initially, the patient was fixed in a semiprone position, from which he could be rotated to a prone or left lateral position. Four ports were inserted, and then the patient was rotated to the prone position. Once the patient was prone, gravity caused the lung to move downwards. Next, the chest cavity was inflated with a CO₂ insufflation pressure of 6 mm Hg. Esophagectomy was then performed, and the lymph nodes in the middle and lower mediastinum and along the right recurrent laryngeal nerve were dissected. In the left upper mediastinum, lymph node dissection was performed after the residual esophagus was stripped. Stripping of the residual esophagus created sufficient working space and a clear operative field for lymph node dissection. VATS-E in the prone position has achieved remarkable results in Japan. It allows a clear operative view of the middle and lower mediastinum, but the working space in the upper mediastinum is limited. Our results indicate that esophageal stripping in prone VATS-E allows for safe and straightforward lymph node dissection along the left recurrent laryngeal nerve. Our technique overcame the difficulties usually encountered with this type of lymph node dissection.

J Nippon Med Sch 2011; 78: 199-204

Keywords
video-assisted thoracoscopic surgery of the esophagus, prone position, stripping

Correspondence to
Hiroshi Makino, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
himiyumo@nms.ac.jp

Received, December 29, 2010
Accepted, February 25, 2011