Page 24 - Read Online

Shirakawa et al. Mini-invasive Surg 2020;4:33 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.30

Original Article Open Access

Standardization of bilateral upper mediastinal lymph
node dissection using microanatomical concepts in

minimally invasive esophagectomy

Yasuhiro Shirakawa, Kazuhiro Noma, Naoaki Maeda, Shunsuke Tanabe, Kazufumi Sakurama, Toshiyoshi
Fujiwara

Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences, Okayama 700-8558, Japan.

Correspondence to: Dr. Yasuhiro Shirakawa, Department of Gastroenterological Surgery, Okayama University Graduate School
of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
E-mail: yasuwr@md.okayama-u.ac.jp
How to cite this article: Shirakawa Y, Noma K, Maeda N, Tanabe S, Sakurama K, Fujiwara T. Standardization of bilateral upper
mediastinal lymph node dissection using microanatomical concepts in minimally invasive esophagectomy. Mini-invasive Surg
2020;4:33. http://dx.doi.org/10.20517/2574-1225.2020.30

Received: 15 Mar 2020 First Decision: 8 Apr 2020 Revised: 15 Apr 2020 Accepted: 24 Apr 2020 Published: 16 Jun 2020
Science Editor: Itasu Ninomiya Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Abstract
Aim: We have recently standardized upper mediastinal lymph node dissection (UMLND) based on
microanatomical concepts in minimally invasive esophagectomy using a 4K ultra-high-definition (HD) system. In
this study, the aim was to investigate the outcomes of microanatomy-based standardization using 4K ultra-HD for
UMLND with the main focus on thoracoscopic operative time.

Methods: We have performed more than 500 cases of thoracoscopic esophagectomy in the prone position as
minimally invasive esophagectomy. After about 400 cases of thoracoscopic esophagectomy in the prone position,
we established the microanatomy-based standardization of UMLND using a 4K ultra-HD system. Two groups
were analyzed: a pre-standardization group (n = 100) and a post-standardization group (n = 100). Furthermore,
the change in our thoracoscopic operative time for all cases was analyzed using the moving average method.

Results: In the post-standardization group, the rate of surgeries performed by operators with less than 20 years’
experience was significantly higher (P < 0.001). There were no significant differences in the number of mediastinal
lymph nodes dissected, intraoperative blood loss and total postoperative morbidity rates between the two
groups. The rate of recurrent laryngeal nerve palsy decreased to less than half (19.8% to 9.6%) (P = 0.061) and
the thoracoscopic operative time decreased [232.0 (202.8-264.0) min to 209.0 (176.0-235.0) min] significantly

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

www.misjournal.net