Laparoscopic mediastinal dissection via an open left diaphragm approach for advanced Siewert type II adenocarcinoma

Shuji Takiguchi, Yasuhiro Miyazaki, Naoki Shinno, Tomoki Makino, Tsuyoshi Takahashi, Yukinori Kurokawa, Makoto Yamasaki, Kiyokazu Nakajima, Hiroshi Miyata, Masaki Mori, Yuichiro Doki

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


Around the lower esophagus, the diaphragm obstructs the laparoscopic dissection of mediastinal lymph nodes in surgery for Siewert type II cancer. To address this problem, we developed the open left diaphragm approach. After dissecting the esophageal hiatus along the diaphragm, the anterior mediastinum is dissected along the pericardium. The left side of the mediastinal pleura is then opened and the left diaphragm is incised with a 60-mm linear stapler to create sufficient working space in the lower mediastinum for the lower mediastinal lymph nodes to be resected with a good view. Six patients who received neoadjuvant chemotherapy underwent mediastinal dissection using this technique. The median operative time and estimated blood loss were 479 (390–750) min and 250 (130–500) ml, respectively, and there were no deaths or severe complications. The open left diaphragm approach provides clear surgical space and a good view for performing mediastinal lymph node dissection and is useful for laparoscopic mediastinal dissection and reconstruction.

Original languageEnglish
Pages (from-to)129-134
Number of pages6
JournalSurgery today
Issue number1
Publication statusPublished - Jan 1 2016
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery


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