Abstract
Background
Esophagogastric junction cancer has been increasing recently. As a result, opportunities to perform transhiatal lower mediastinal lymphadenectomy are also increasing. Laparoscopic surgery is useful because the operating field of this site is too deep and narrow to perform laparotomy. But the anatomy of this area is not sufficiently clarified, and since there are few structures as landmarks, it is difficult to set the range and depth of lymph node dissection.
Methods
We have been verifying anatomically and embryologically the infracardiac bursa (ICB) identified as a closed lumen between the esophagus and the right crus of the diaphragm during an operation. We standardized the procedure of transhiatal lower mediastinal lymphadenectomy setting several landmarks including ICB.
Results
In transhiatal lower mediastinal lymphadenectomy, it is possible to do a precise lymphadenectomy by setting several landmarks including the ICB and standardizing each procedure on the ventral side, dorsal side, and both sides of the esophagus. In the case of advanced cancer which invades organs around the hiatus, it is difficult to perform routine dissection by using the infracardiac bursa or the dissectable layer. Understanding of the anatomy of this area will support the safe and precise lymphadenectomy.
Conclusion
In this presentation, we will show the procedure of transhiatal lower mediastinal lymphadenectomy using the ICB as a landmark.
Disclosure
All authors have declared no conflicts of interest.
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