285. HOW TO DO IT? SUPRACARINAL APPROACH OF THE LEFT RECURRENT LARYNGEAL NERVE AREA FOR LYMPHADENECTOMY DURING THORACOSCOPIC ESOPHAGECTOMY

It is important to know the anatomical relationships of the left recurrent laryngeal nerve during the total mediastinal lymphadenectomy. The objective of this procedure is to resect the lymph nodes located in this area without damaging the nerve. In order to approach the left recurrent laryngeal nerve (LRLN) area it is important to know different strategies to achieve this objective. This video illustrates different ways of approaching the LRLN area during thoracoscopic esophagectomy. The first approach illustrated, the esophagus is completely retracted to the right side. With this strategy it is possible to visualize the left paratracheal groove, and tissues and lymph nodes around LRLN are tented. The next approach consists of leaving the esophagus attached on its right and anterior side, creating an ample window, through which the LRLN area can be approached. Another approach involves section of the proximal esophagus. Once that the esophagus is dissected to the thoracic apex, it is divided proximal of the tumor with a stapler. Retraction of this stump creates an optimal view of the area. Standardization of the supracarinal approach is necessary to improve dissection of the LRLN area and achieve a more adequate surgical resection with a low rates of complications.