ArticleSurgical endoscopy2022
Laparoscopic creation of a retrosternal route for gastric conduit reconstruction.
Article in Surgical endoscopy, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 12 citations in OpenAlex.
- Learning curve and perioperative outcomes: a retrospective cohort study between synchronous and combined inflatable mediastinoscope-laparoscopic radical esophagectomy.Surgical endoscopy · 2026Article
- The correlation between intrathoracic herniation of the gastric tube and postoperative complications and the efficacy of laparoscopic retrosternal route creation.Esophagus : official journal of the Japan Esophageal Society · 2025Article
- A approach of gastric conduit via the anterior of pulmonary hilum route during minimally invasive McKeown esophagectomy.Journal of cardiothoracic surgery · 2024Article
- Comparison of substernal and posterior mediastinal route of reconstruction after minimally invasive esophagectomy for esophageal cancer.Langenbeck's archives of surgery · 2024Article
- ASO Author Reflections: Laparoscopic Retrosternal Route Creation after Minimally Invasive Esophagectomy is Associated with Good Reconstructed Conduit Function without Increasing Risk of Surgical Complications.Annals of surgical oncology · 2023Article
- Efficacy and Postoperative Outcomes of Laparoscopic Retrosternal Route Creation for the Gastric Conduit: Propensity Score-Matched Comparison to Posterior Mediastinal Reconstruction.Annals of surgical oncology · 2023Article
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Authors and funding
13 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRetrosternal reconstruction is associated with a lower risk of mediastinitis, gastro-tracheal fistula, and hiatal hernia. Historically, traumatic manual creation of the retrosternal tunnel has been performed using one's fist. We report a novel and atraumatic laparoscopic procedure to create the retrosternal route.
methodsWe have laparoscopically created the retrosternal route in 25 thoracoscopic, mediastinoscopic, or robot-assisted minimally invasive esophagectomies since August 2019. Specifically, a peritoneal incision is started at the dorsal side of the xiphoid process. Through a 12-mm port inserted slightly to the right of and superior to the umbilical camera port, we dissect loose connective tissues from the caudal to the cranial side using behind the sternum and inside the internal thoracic vessels as landmarks. The time required to create the route was calculated. Then, the cumulative sum (CUSUM) method and the simple moving average of five cases were used to evaluate the learning curve of this novel procedure. Operative outcomes were analyzed according to the learning curve results and also compared with 25 cases of postmediastinal reconstruction counterparts.
resultsTwenty-five patients were divided into the early group (six patients) and late group (19 patients) based on the peak of the CUSUM chart. The time required for route creation was 28.5 min (median) in the early and 15 min in the late group, indicating a significant difference (P = 0.038). The overall incidence of pleural injury was 20% (5 of 25 patients), with no significant difference between the groups. There was no significant difference in the incidence of perioperative complications. Also, there were no significant differences in perioperative complications or gastric conduit functions 1 year after surgery between the retrosternal and the postmediastinal reconstruction.
conclusionLaparoscopic creation of a retrosternal route for gastric conduit reconstruction is safe and feasible and has a short learning curve.
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