Laparoscopic mediastinal dissection via an open left diaphragm approach for advanced Siewert type II adenocarcinoma

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• 作者：Shuji Takiguchi ; Yasuhiro Miyazaki ; Naoki Shinno ; Tomoki Makino…
• 关键词：Laparoscopic gastrectomy ; Mediastinal ; Esophagogastric junction ; Lymph node dissection
• 刊名：Surgery Today
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：46
• 期：1
• 页码：129-134
• 全文大小：2,153 KB
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• 作者单位：Shuji Takiguchi (1)
  Yasuhiro Miyazaki (1)
  Naoki Shinno (1)
  Tomoki Makino (1)
  Tsuyoshi Takahashi (1)
  Yukinori Kurokawa (1)
  Makoto Yamasaki (1)
  Kiyokazu Nakajima (1)
  Hiroshi Miyata (1)
  Masaki Mori (1)
  Yuichiro Doki (1)
  
  1. Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2, E2, Yamadaoka, Suita, Osaka, 565-0871, Japan
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Abdominal Surgery
  Thoracic Surgery
  Vascular Surgery
  Cardiac Surgery
  Surgical Oncology
  
• 出版者：Springer Japan
• ISSN：1436-2813

文摘

Around the lower esophagus, the diaphragm obstructs the laparoscopic dissection of mediastinal lymph nodes in surgery for Siewert type II cancer. To address this problem, we developed the open left diaphragm approach. After dissecting the esophageal hiatus along the diaphragm, the anterior mediastinum is dissected along the pericardium. The left side of the mediastinal pleura is then opened and the left diaphragm is incised with a 60-mm linear stapler to create sufficient working space in the lower mediastinum for the lower mediastinal lymph nodes to be resected with a good view. Six patients who received neoadjuvant chemotherapy underwent mediastinal dissection using this technique. The median operative time and estimated blood loss were 479 (390鈥?50) min and 250 (130鈥?00) ml, respectively, and there were no deaths or severe complications. The open left diaphragm approach provides clear surgical space and a good view for performing mediastinal lymph node dissection and is useful for laparoscopic mediastinal dissection and reconstruction. Keywords Laparoscopic gastrectomy Mediastinal Esophagogastric junction Lymph node dissection