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Tokairin et al. Mini-invasive Surg 2020;4:32 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.23

Technical Note Open Access

Mediastinoscopic esophagectomy with lymph
node dissection using a bilateral transcervical and
transhiatal pneumomediastinal approach

Yutaka Tokairin , Yasuaki Nakajima , Kenro Kawad , Akihiro Hoshin , Takuya Okada , Toshihiro
2
2
2
2
1,2
Matsui , Kazuya Yamaguchi , Kagami Nagai , Yusuke Kinugasa 2
2
2
2
1 Department of Surgery, Toshima Hospital Tokyo Metropolitan Health and Hospitals Corporation, Tokyo 173-0015, Japan.
2 Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.
Correspondence to: Dr. Yutaka Tokairin, Department of Surgery, Toshima Hospital Tokyo Metropolitan Health and Hospitals
Corporation, 33-1 Sakaecho, Itabashi-ku, Tokyo 173-0015, Japan. E-mail: tokairin.srg1@tmd.ac.jp
How to cite this article: Tokairin Y, Nakajima Y, Kawad K, Hoshin A, Okada T, Matsui T, Yamaguchi K, Nagai K, Kinugasa Y.
Mediastinoscopic esophagectomy with lymph node dissection using a bilateral transcervical and transhiatal pneumomediastinal
approach. Mini-invasive Surg 2020;4:32. http://dx.doi.org/10.20517/2574-1225.2020.23
Received: 17 Feb 2020 First Decision: 17 Mar 2020 Revised: 24 Mar 2020 Accepted: 1 Apr 2020 Published: 16 May 2020
Science Editor: Itasu Ninomiya Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
We developed a method for mediastinoscopic esophagectomy via a bilateral transcervical and transhiatal
approach under pneumomediastinum as a less-invasive radical operation. The right recurrent nerve is first
identified using an open approach, and the right cervical paraesophageal lymph nodes and part of the right
recurrent nerve lymph nodes are dissected, after which pneumomediastinum is initiated. The upper thoracic
paraesophageal lymph nodes and right recurrent nerve lymph nodes are dissected along the right vagus nerve. The
dorsal side of the esophagus is dissected along the visceral sheath taking care to avoid thoracic duct injury and
is then dissected along the vascular sheath in front of the descending aorta. The esophagus is dissected from the
trachea at the caudal side of the aortic arch, and then dissected along the ventral side of the left main bronchus,
reaching the pulmonary artery. Finally, the right recurrent nerve lymph nodes around the right subclavian artery are
completely retrieved. The left cervical approach is almost the same as that via the right side. The dorsal side of the
esophagus is almost dissected along the visceral sheath with a right transcervical approach. The subaortic arch to
the left tracheobronchial lymph nodes are dissected using the crossover technique. These lymph nodes are easily
dissected by cutting the left and ventral side of the lymph nodes because the caudal side is already dissected in
the right transcervical approach. A bilateral (especially right trans-cervico-pneumomediastinal) approach is useful
for bilateral upper mediastinal lymph node dissection and esophagectomy.

Keywords: Minimally invasive esophagectomy, cervical approach, esophageal cancer, mediastinoscopic
esophagectomy, pneumomediastinum, mediastinoscopic esophagectomy with lymph node dissection

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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