[Continuous dissection of the posterior mediastinal and abdominal lymph nodes using a laparoscopic transhiatal approach for esophageal cancer].

We began performing laparoscopic transhiatal esophagectomies in patients with esophageal cancer in 2009. By June 2014, 172 patients had undergone this procedure. The main advantage of this method was that the dissection of the posterior mediastinal and abdominal lymph nodes(LNs)could be performed continuously under a magnified videoscopic view. An abdominal wall sealing device was placed in the upper abdomen, and 4 ports were inserted. The esophageal hiatus was opened, and carbon dioxide was introduced into the mediastinum. The posterior plane of the pericardium was separated and extended, and the anterior side of each posterior mediastinal LN was separated. The thoracic aorta's adventitia was exposed, and the posterior sides of the LNs were then separated. While lifting the LNs like a membrane, they were resected along the border of the left mediastinal pleura. Subsequently, dissection of the posterior mediastinal LNs was extended towards the caudal side from the crural diaphragm to the celiac artery. Thus, the LNs along the celiac and left gastric artery were dissected en bloc from the left side. Our surgical procedure allowed good views during surgery, and the continuous dissection of the posterior mediastinal and abdominal LNs was performed safely.