Landmarks of topographic-anatomical navigation during thoracoscopic esophagectomy

• Tatiana V. Khorobryh
• Sergey S. Dydykin
• Natalia P. Mishchenko
• Salikhov R.E.
• Klaushuk A.E.

Abstract

Background. Thoracoscopic access for surgical interventions in patients with esophageal cancer is currently the most optimal, but there are difficulties increasing the probability of damage to vital structures of the posterior mediastinum

Aim - development of a topographic-anatomical navigation system to increase safety and oncological radicality of thoracoscopic esophageal extirpation in patients with esophageal cancer. 

Material and methods. The anatomical part of the study was performed on 30 human biomaneken. The anatomical structures of the posterior mediastinum were studied without opening the mediastinal pleura. The obtained data were applied in clinical practice, where 23 surgical interventions were performed: 15 - in a routine way, 8 - with the use of topographic-anatomical navigation.

Results. The main anatomical landmarks without mediastinal pleura opening were: v. azygos, arch of v. azygos, superior vena cava, n. vagus, right recurrent nerve, pulmonary ligament.

Application of the topographic-anatomical navigation system permitted to perform surgical intervention more safely without traumatization of the thoracic lymphatic duct and the thoracic aorta in comparison with the group of patients without navigation system. Also, the number of postoperative pneumonias decreased to 2 (25%) cases in the group with the navigation scheme compared to the group without navigation system - 5 (33.3%). The number of removed lymph nodes was increased in the group of patients with the use of topographic-anatomic navigation and was 32±4, in comparison with the group without navigation scheme - 27±3. The use of the navigation chart also contributed to reducing the hospitalization period to 12±3 days, which was less by 3 days, compared with 15±2 days in the group without the navigation system.

Conclusion. The developed system of embryo-oriented topographic-anatomical navigation allows to safely dissect anatomical structures of the posterior mediastinum and improves the results of surgical treatment of patients with thoracic esophageal cancer.

Keywords:anatomic landmarks; minimally invasive esophagectomy; esophageal cancer; thoracoscopic surgery

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