Abstract
Background
The structure of the fascia in upper mediastinum has already been reported from gross anatomical viewpoints by Sarrazin. But it is necessary to understand meticulous anatomy for thoracoscopic or mediastinoscopic surgery. So herein, we investigate histologically the thin membranous structure made of dense connective tissues.
Methods
Semi-sequential transverse sections of the mediastinum were obtained from three cadavers. Hematoxylin and eosin staining, Elastica van Gieson staining, and Masson trichrome staining were performed to identify the presence and location of the thin membranous structure made of dense connective tissues.
Results
The “visceral sheath” and “vascular sheath,” as previously described by Sarrazin, were observed histologically. These two thin membranous structures do not surround the esophagus and trachea cylindrically. In addition, the “visceral sheath” on the right side of the upper mediastinum was unclear in comparison to the left side. The “visceral sheath” (on the left side) gradually became unclear, and seemed to almost disappear; the esophagus was found to be very close to the thoracic duct on the caudal side of the bifurcation of the trachea. Although the left recurrent nerve was located inside the “visceral sheath” in all cadavers, the left recurrent nerve lymph nodes were located inside the “visceral sheath” in cadaver 1 and between the “visceral sheath” and “vascular sheath” in cadaver 3.
Conclusion
The “visceral sheath” around the esophagus in the upper mediastinum was histologically demonstrated; however, the findings were not constant.
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References
Burns A. Observations on the surgical anatomy of the head and neck. Glasgow: Wardlaw & Cunningham; 1824.
Malgaigne J-F. Traité d’anatomie chirurgicale et de chirurgie expérimentale, Tome second. Paris: J-B Baillière et fils; 1859.
Natale G, Condino S, Stecco A, et al. Is the cervical fascia an anatomical proteus? Surg Radiol Anat. 2015;37:1119–27.
Khan AA, Zhang M. Head and Neck. In: Standring S, editor. Gray’s Anatomy. Fortieth ed. London: Elsevier; 2008. p. 438–40.
Sarrazin R, Voog R. Anatomical background to mediastinoscopy. In: Jepsen O, Sørensen HR, editors. Mediastinoscopy. Odense: Odense University Press; 1971. p. 6–10.
Tokairin Y, Nagai K, Fujiwara H, et al. Mediastinoscopic subaortic and tracheobronchial lymph node dissection with a new cervico-hiatal crossover approach in thiel-embalmed cadavers. Int Surg. 2015;100:580–8.
Meyer P, Sublon R. [Considerations on the interpleural ligament (De Morosow)] (in fre). Arch Anat Pathol (Paris). 1961;9:111–5.
Kinugasa Y, Murakami G, Suzuki D, et al. Histological identification of fascial structures posterolateral to the rectum. Br J Surg. 2007;94:620–6.
Nakajima Y, Tokairin Y, Nakajima Y, et al. Anatomical study of the left superior mediastinal lymphatics for tracheal branches of left recurrent laryngeal nerve-preserving mediastinoscope-assisted surgery in esophageal cancer. Surg Today. 2017;48:333–7.
Weijs TJ, Goense L, van Rossum PS, et al. The peri-esophageal connective tissue layers and related compartments: visualization by histology and magnetic resonance imaging. J Anat. 2017;230:262–71.
Scali F, Nash LG, Pontell ME. Defining the morphology and distribution of the alar fascia: a sheet plastination investigation. Ann Otol Rhinol Laryngol. 2015;124:814–9.
Japan Esophageal S. Japanese Classification of Esophageal Cancer, 11th Edition: part II and III. Esophagus. 2017;14:37–65.
Japan Esophageal S. Japanese Classification of Esophageal Cancer, 11th Edition: part I. Esophagus. 2017;14:1–36.
Cuschieri A, Shimi S, Banting S. Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb. 1992;37:7–11.
Jarral OA, Purkayastha S, Athanasiou T, et al. Should thoracoscopic three-stage esophagectomy be performed in the prone or left lateral decubitus position? Interact Cardiovasc Thorac Surg. 2011;13:60–5.
Law S, Fok M, Chu KM, et al. Thoracoscopic esophagectomy for esophageal cancer. Surgery. 1997;122:8–14.
Smithers BM, Gotley DC, Martin I, et al. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg. 2007;245:232–40.
Acknowledgements
We thank Ms. Yoko Takagi for technical assistance in performing histological staining and Dr Kumiko Yamaguchi for technical support in anatomical procedure.
Funding
This work was partly supported by JSPS KAKENHI Grant Number JP23590216.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.
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All authors declare that they have no conflict of interest.
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Tokairin, Y., Nakajima, Y., Kawada, K. et al. Histological study of the thin membranous structure made of dense connective tissue around the esophagus in the upper mediastinum. Esophagus 15, 272–280 (2018). https://doi.org/10.1007/s10388-018-0625-9
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DOI: https://doi.org/10.1007/s10388-018-0625-9