Simple technique of azygos arch division and retraction for minimally invasive esophagectomy.
Shigeru TsunodaKazutaka ObamaShigeo HisamoriKyoichi HashimotoTatsuto NishigoriYoshiharu SakaiPublished in: Esophagus : official journal of the Japan Esophageal Society (2020)
The azygos arch is usually divided during esophagectomy. To achieve thorough lymphadenectomy up to upper mediastinum, many surgeons prefer to retract the distal stump of the azygos arch by pulling out the thread which ligates the stump to the skin through the dorsal side of the intercostal space. However, the access to the dorsal chest wall near vertebrae for percutaneous puncture is difficult during robot-assisted minimally invasive esophagectomy in the prone position. This paper reports a new simple method of azygos arch division and retraction using a polymer locking ligation system Hem-o-lok (Teleflex, Morrisville, NC, USA) and a barbed suture device. This technique can be easily performed completely as a robotic procedure without extra puncture, and it is also applicable for conventional thoracoscopic procedures with the potential benefits of less trauma and bleeding.
Keyphrases
- robot assisted
- minimally invasive
- inferior vena cava
- aortic dissection
- spinal cord
- neuropathic pain
- pulmonary embolism
- ultrasound guided
- thoracic surgery
- emergency department
- atrial fibrillation
- climate change
- radiation therapy
- adverse drug
- soft tissue
- risk assessment
- neoadjuvant chemotherapy
- human health
- electronic health record