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Novel “Modified Bascule Method” for Lymphadenectomy Along the Left Recurrent Laryngeal Nerve During Robot-Assisted Minimally Invasive Esophagectomy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Given the worldwide popularization of conventional minimally invasive esophagectomy (C-MIE), robot-assisted MIE (RAMIE) can be expected to provide a finer procedure. However, controversy remains regarding whether RAMIE is superior to C-MIE in preventing recurrent laryngeal nerve (RLN) palsy. Considering the shallow learning curve for RAMIE, a novel procedure for lymphadenectomy along the RLN during RAMIE is needed.

Methods

Based on a logical and simple understanding of the left upper mediastinum anatomy, the authors developed a novel “modified bascule method” for RAMIE that could simplify lymphadenectomy along the left RLN and prevent it from being touched and stretched. Between 2018 and 2020, 46 patients with esophageal carcinoma underwent RAMIE using this method at Kobe University.

Results

The modified bascule method was used to perform RAMIE for 29 men and 17 women with a median age of 67 years (range, 49–82 years). The median thoracoscopic procedure time was 438 min (range, 344–625 min), and the median console time was 351 min (range 273–518 min). The study harvested a median of 24 (range, 8–34) lymph nodes from the thoracic portion and 4 (range, 0–10) lymph nodes from along the left RLN. The mortality rate was 0%. Postoperative left RLN palsy classified as Clavien–Dindo (C–D) grade 1 or higher was observed for 9 patients (19%), whereas grade 2 or higher was not seen (0%). Pneumonia and anastomotic leakage rates higher than C–D grade 2 were respectively 13% and 19%.

Conclusions

The novel modified bascule method for RAMIE can promote feasible lymphadenectomy along the left RLN even when performed during the learning period.

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Acknowledgments

Informed consent was obtained from patients for the publication of this report and any accompanying data. Patient anonymity was maintained.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan

    Taro Oshikiri MD, Gosuke Takiguchi MD, Naoki Urakawa MD, Hiroshi Hasegawa MD, Masashi Yamamoto MD, Shingo Kanaji MD, Kimihiro Yamashita MD, Tetsu Nakamura MD & Yoshihiro Kakeji MD

  2. Division of Minimally Invasive Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan

    Takeru Matsuda MD

  3. Division of Community Medicine and Medical Network, Department of Social Community Medicine and Health Science, Graduate School of Medicine, Kobe University, Kobe, Japan

    Satoshi Suzuki MD

Authors
  1. Taro Oshikiri MD
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  2. Gosuke Takiguchi MD
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  4. Hiroshi Hasegawa MD
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  9. Tetsu Nakamura MD
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  11. Yoshihiro Kakeji MD
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Correspondence to Taro Oshikiri MD.

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Oshikiri, T., Takiguchi, G., Urakawa, N. et al. Novel “Modified Bascule Method” for Lymphadenectomy Along the Left Recurrent Laryngeal Nerve During Robot-Assisted Minimally Invasive Esophagectomy. Ann Surg Oncol 28, 4918–4927 (2021). https://doi.org/10.1245/s10434-021-09738-w

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  • DOI: https://doi.org/10.1245/s10434-021-09738-w

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