A preliminary study of modified inflatable mediastinoscopic and single-incision plus one-port laparoscopic esophagectomy

Hua Tang; Zhihao Song; Rongqiang Wei; Kai Yan; Zihao Chen; Kenan Huang; Ning Xin; Noriyuki Hirahara; Inderpal S Sarkaria; Xinyue Li; Bin Wu; Zhifei Xu

doi:10.21037/jtd-24-309

A preliminary study of modified inflatable mediastinoscopic and single-incision plus one-port laparoscopic esophagectomy

J Thorac Dis. 2024 Apr 30;16(4):2472-2481. doi: 10.21037/jtd-24-309. Epub 2024 Apr 26.

Authors

Hua Tang^#¹, Zhihao Song^#¹, Rongqiang Wei^#¹, Kai Yan¹, Zihao Chen¹, Kenan Huang¹, Ning Xin², Noriyuki Hirahara³, Inderpal S Sarkaria⁴, Xinyue Li¹, Bin Wu¹, Zhifei Xu¹

Affiliations

¹ Department of Thoracic Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China.
² Department of Thoracic Surgery, People's Liberation Army 960th Hospital, Jinan, China.
³ Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Japan.
⁴ Division of Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

^# Contributed equally.

Abstract

Background: Esophageal malignancies have a high morbidity rate worldwide, and minimally invasive surgery has emerged as the primary approach for treating esophageal cancer. In recent years, there has been increasing discussion about the potential of employing inflatable mediastinoscopic and laparoscopic approaches as an option for esophagectomy. Building on the primary modification of the inflatable mediastinoscopic technique, we introduced a secondary modification to further minimize surgical trauma.

Methods: We conducted a retrospective analysis of patients who underwent inflatable mediastinoscopy combined with laparoscopic esophagectomy at the Second Affiliated Hospital of Naval Medical University from March 2020 to March 2023. The patients were allocated to the following two groups: the traditional (primary modification) group, and the secondary modification group. Operation times, intraoperative bleeding, and postoperative complications were compared between the groups.

Results: The procedure was successfully performed in all patients, and conversion to open surgery was not required in any case. There were no statistically significant differences in the surgical operation time, intraoperative bleeding, number of dissected lymph nodes, and rate of postoperative anastomotic leakage between the two groups. However, a statistically significant difference was observed in the length of the mobilized esophagus between the two groups. The mobilization of esophagus to the level of diaphragmatic hiatus via the cervical incision was successfully achieved in more patients in the secondary modification group than the primary modification group.

Conclusions: Inflatable mediastinoscopy combined with single-incision plus one-port laparoscopic esophagectomy is a safe and effective surgical procedure. The use of a 5-mm flexible endoscope, ultra-long five-leaf forceps, and LigaSure Maryland forceps facilitates esophageal mobilization and lymph node dissection through a single cervical incision.

Keywords: Esophageal cancer; inflatable mediastinoscopic esophagectomy; minimally invasive esophagectomy.