PS01.129: A NEW ANIMAL TRAINING MODEL FOR MEDIASTINAL LYMPHADENECTOMY WITH A SINGLE-PORT MEDIASTINOSCOPIC CERVICAL APPROACH

• Published in: Diseases of the esophagus Vol. 31; no. Supplement_1; p. 86
• Main Authors: Kikuchi, Hirotoshi, Soneda, Wataru, Kawata, Sanshiro, Hirotsu, Amane, Murakami, Tomohiro, Matsumoto, Tomohiro, Ozaki, Yusuke, Hiramatsu, Yoshihiro, Kamiya, Kinji, Takeuchi, Hiroya
• Format: Journal Article
• Language: English
• Published: 01-09-2018
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1093/dote/doy089.PS01.129

Abstract
Background
Single-port mediastinoscope-assisted transhiatal esophagectomy for thoracic esophageal cancer is a minimally invasive surgery and can be applied to patients with low pulmonary function. However, special skills are needed to safely perform this surgical procedure as a curative operation without complications such as recurrent laryngeal nerve paralysis. To date, no animal training models for this surgical procedure has not been established. In this study, we developed a new animal training model for mediastinal lymphadenectomy with a single-port mediastinoscopic cervical approach.
Methods
A domestic pig was intubated, with a normal tracheal tube, and placed in a spine position. Because pigs do not have clavicles, skin incision was made on the cephalic side of the left forelimb. Anterior cervical muscles were cut and cephalic parts of thymus and left thyroid were resected to deploy the operation field. Esophagus and left recurrent laryngeal nerve were identified behind the trachea. A wound edge protector (Lap-Protector) and EZ Access was attached to the wound. An artificial pneumomediastinum was created using 5–6 mmHg of CO2 gas and three 5mm ports were inserted to EZ Access. Operator dissected connective tissues around esophagus and vessels mainly using a bipolar sealing device. At the right side of the esophagus, fat tissue with 106recL lymph nodes was dissected from tracheal wall. After dissection was reached to the carina level, esophagotracheal ligament was cut and dissection on the left side of esophagus was carried out to the level of aortic arch. By displacing the trachea to the front side, 109R, 107 and 109L lymph node were dissected.
Results
Because pig's tracheal cartilage is sub-circumferential, mobility of trachea is relatively poor, and risks of tracheal membranous portion damage are low. Although there are some anatomical differences between pigs and human, this animal training model reproduces surgical procedures of mediastinal lymphadenectomy in human such as forceps operation techniques in narrow fields and effects of artificial pneumomediastinum.
Conclusion
We established a new animal training model for mediastinal lymphadenectomy with a single-port mediastinoscopic cervical approach. This model reproduces surgical procedures in human and is useful for training surgeons who wish to start performing mediastinal lymphadenectomy by mediastinoscopic cervical approach.
Disclosure
All authors have declared no conflicts of interest.