{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T22:41:35Z","timestamp":1792363295244,"version":"4.4.0"},"reference-count":16,"publisher":"International College of Surgeons","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:p>The use of mediastinal surgery for minimally invasive esophagectomy (MIE) has been proposed; however, this method is not performed as radical surgery because it has been thought to be impossible to perform complete upper mediastinal dissection, including the left tracheobronchial lymph nodes (106tbL). We herein describe a new method for performing complete dissection of the upper mediastinum. We developed a method for performing complete mediastinoscopic esophagectomy as radical surgery via the bilateral transcervical and transhiatal approach in 6 Thiel-embalmed human cadavers. The lower and middle mediastinal lymph nodes are dissected via the transhiatal approach. The dorsal side of the left recurrent nerve is dissected up to the aortic arch and left recurrent nerve lymph nodes (106recL) are dissected under pneumomediastinum. Next, the right recurrent nerve lymph nodes (106recR) are dissected. The cartilage of the left main bronchus is dissected and pushed downward, thereby obtaining a good view between the aortic arch and left main bronchus via the transhiatal approach. The 106tbL lymph nodes are dissected until the aortic arch is reached. Simultaneously, the lymph nodes are dissected via a right cervical incision. This method is termed the \u201ccross-over technique.\u201d We herein demonstrated that the upper mediastinal lymph nodes, including the 106tbL nodes, can be dissected using the bilateral transcervical and transhiatal approach under pneumomediastinum and named this method \u201cmediastinoscopic esophagectomy with lymph node dissection\u201d (MELD). MELD is therefore considered to be a useful modality based on our experience with Thiel-embalmed human cadavers.<\/jats:p>","DOI":"10.9738\/intsurg-d-14.00305.1","type":"journal-article","created":{"date-parts":[[2015,4,15]],"date-time":"2015-04-15T20:49:52Z","timestamp":1429130992000},"page":"580-588","source":"Crossref","is-referenced-by-count":13,"title":["Mediastinoscopic Subaortic and Tracheobronchial Lymph Node Dissection With a New Cervico-Hiatal Crossover Approach in Thiel-Embalmed Cadavers"],"prefix":"10.9738","volume":"100","author":[{"given":"Yutaka","family":"Tokairin","sequence":"first","affiliation":[{"name":"Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kagami","family":"Nagai","sequence":"additional","affiliation":[{"name":"Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisashi","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taichi","family":"Ogo","sequence":"additional","affiliation":[{"name":"Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Okuda","sequence":"additional","affiliation":[{"name":"Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuaki","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenro","family":"Kawada","sequence":"additional","affiliation":[{"name":"Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Miyawaki","sequence":"additional","affiliation":[{"name":"Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisayo","family":"Nasu","sequence":"additional","affiliation":[{"name":"Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichi","family":"Akita","sequence":"additional","affiliation":[{"name":"Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuyuki","family":"Kawano","sequence":"additional","affiliation":[{"name":"Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4721","reference":[{"issue":"1","key":"i0020-8868-100-4-580-b01","series-title":"Surg Endosc","first-page":"188","article-title":"Robotically assisted laparoscopic transhiatal esophagectomy","volume":"22","author":"Galvani\n              CA,","year":"2008","unstructured":"Galvani\n              CA, \n            \n              Gorodner\n              MV, \n            \n              Moser\n              F, \n            \n              Jacobsen\n              G, \n            \n              Chretien\n              C, \n            \n              Espat\n              NJ\n            \n            et al\n          . Robotically assisted laparoscopic transhiatal esophagectomy. Surg Endosc2008;22(1):188\u2013195"},{"issue":"8","key":"i0020-8868-100-4-580-b02","series-title":"Br J Surg","first-page":"878","article-title":"Borel Rinkes IH, Cromheecke GJ, van Hillegersberg R. Robot-assisted thoracoscopic oesophagectomy for cancer","volume":"96","author":"Boone\n              J,","year":"2009","unstructured":"Boone\n              J, \n            \n              Schipper\n              ME, \n            \n              Moojen\n              WA, \n          \n          Borel Rinkes IH, Cromheecke GJ, van Hillegersberg R. Robot-assisted thoracoscopic oesophagectomy for cancer. Br J Surg2009;96(8):878\u2013886"},{"issue":"5","key":"i0020-8868-100-4-580-b03","series-title":"Br J Anaesth","first-page":"633","article-title":"Peri-operative risk factors for acute lung injury after elective oesophagectomy","volume":"86","author":"Tandon\n              S,","year":"2001","unstructured":"Tandon\n              S, \n            \n              Batchelor\n              A, \n            \n              Bullock\n              R, \n            \n              Gascoigne\n              A, \n            \n              Griffin\n              M, \n            \n              Hayes\n              N\n            \n            et al\n          . Peri-operative risk factors for acute lung injury after elective oesophagectomy. Br J Anaesth2001;86(5):633\u2013638"},{"issue":"3","key":"i0020-8868-100-4-580-b04","series-title":"Eur J Cardiothorac Surg","first-page":"379","article-title":"Postresectional pulmonary oxidative stress in lung cancer patients. The role of one-lung ventilation","volume":"27","author":"Misthos\n              P,","year":"2005","unstructured":"Misthos\n              P, \n            \n              Katsaragakis\n              S, \n            \n              Milingos\n              N, \n            \n              Kakaris\n              S, \n            \n              Sepsas\n              E, \n            \n              Athanassiadi\n              K\n            \n            et al\n          . Postresectional pulmonary oxidative stress in lung cancer patients. The role of one-lung ventilation. Eur J Cardiothorac Surg2005;27(3):379\u2013382; discussion 382\u2013383"},{"issue":"3","key":"i0020-8868-100-4-580-b05","series-title":"Ann Anat","first-page":"185","article-title":"The preservation of the whole corpse with natural color [in German]","volume":"174","author":"Thiel\n              W.","year":"1992","unstructured":"Thiel\n              W.\n            \n          \n          The preservation of the whole corpse with natural color [in German]. Ann Anat1992;174(3):185\u2013195"},{"issue":"3","key":"i0020-8868-100-4-580-b06","series-title":"Ann Anat","first-page":"267","article-title":"Supplement to the conservation of an entire cadaver according to W. Thiel [in German]","volume":"184","author":"Thiel\n              W.","year":"2002","unstructured":"Thiel\n              W.\n            \n          \n          Supplement to the conservation of an entire cadaver according to W. Thiel [in German]. Ann Anat2002;184(3):267\u2013269"},{"issue":"6","key":"i0020-8868-100-4-580-b07","series-title":"Anticancer Res","first-page":"2577","article-title":"Novel technique for dissection of subcarinal and main bronchial lymph nodes using a laparoscopic transhiatal approach for esophageal cancer","volume":"33","author":"Shiozaki\n              A,","year":"2013","unstructured":"Shiozaki\n              A, \n            \n              Fujiwara\n              H, \n            \n              Konishi\n              H, \n            \n              Morimura\n              R, \n            \n              Murayama\n              Y, \n            \n              Komatsu\n              S\n            \n            et al\n          . Novel technique for dissection of subcarinal and main bronchial lymph nodes using a laparoscopic transhiatal approach for esophageal cancer. Anticancer Res2013;33(6):2577\u20132585"},{"issue":"5","key":"i0020-8868-100-4-580-b08","series-title":"J Thorac Cardiovasc Surg","first-page":"643","article-title":"Esophagectomy without thoracotomy","volume":"76","author":"Orringer\n              MB,","year":"1978","unstructured":"Orringer\n              MB, \n            \n              Sloan\n              H.\n            \n          \n          Esophagectomy without thoracotomy. J Thorac Cardiovasc Surg1978;76(5):643\u2013654"},{"issue":"1","key":"i0020-8868-100-4-580-b09","series-title":"J Thorac Cardiovasc Surg","first-page":"267","article-title":"Video-assisted mediastinoscopy improved radical resection for cancer in transhiatal esophagectomy","volume":"133","author":"Pop\n              D,","year":"2007","unstructured":"Pop\n              D, \n            \n              Venissac\n              N, \n            \n              Mouroux\n              J.\n            \n          \n          Video-assisted mediastinoscopy improved radical resection for cancer in transhiatal esophagectomy. J Thorac Cardiovasc Surg2007;133(1):267\u2013268"},{"issue":"1","key":"i0020-8868-100-4-580-b10","series-title":"Ann Surg","first-page":"97","article-title":"Endodissection of the thoracic esophagus. Technique and clinical results in transhiatal esophagectomy","volume":"218","author":"Bumm\n              R,","year":"1993","unstructured":"Bumm\n              R, \n            \n              Holscher\n              AH, \n            \n              Feussner\n              H, \n            \n              Tachibana\n              M, \n            \n              Bartels\n              H, \n            \n              Siewert\n              JR.\n            \n          \n          Endodissection of the thoracic esophagus. Technique and clinical results in transhiatal esophagectomy. Ann Surg1993;218(1):97\u2013104"},{"issue":"8","key":"i0020-8868-100-4-580-b11","series-title":"World J Surg","first-page":"822","article-title":"Radical transhiatal esophagectomy with two-field lymphadenectomy and endodissection for distal esophageal adenocarcinoma","volume":"21","author":"Bumm\n              R,","year":"1997","unstructured":"Bumm\n              R, \n            \n              Feussner\n              H, \n            \n              Bartels\n              H, \n            \n              Stein\n              H, \n            \n              Dittler\n              HJ, \n            \n              Hofler\n              H\n            \n            et al\n          . Radical transhiatal esophagectomy with two-field lymphadenectomy and endodissection for distal esophageal adenocarcinoma. World J Surg1997;21(8):822\u2013831"},{"issue":"3","key":"i0020-8868-100-4-580-b12","series-title":"Surg Endosc","first-page":"383","article-title":"Mediastinoscope-assisted transhiatal esophagectomy for esophageal cancer","volume":"18","author":"Tangoku\n              A,","year":"2004","unstructured":"Tangoku\n              A, \n            \n              Yoshino\n              S, \n            \n              Abe\n              T, \n            \n              Hayashi\n              H, \n            \n              Satou\n              T, \n            \n              Ueno\n              T\n            \n            et al\n          . Mediastinoscope-assisted transhiatal esophagectomy for esophageal cancer. Surg Endosc2004;18(3):383\u2013389"},{"issue":"12","key":"i0020-8868-100-4-580-b13","series-title":"Surg Endosc","first-page":"3865","article-title":"Transcervical videoscopic esophageal dissection during two-field minimally invasive esophagectomy: early patient experience","volume":"25","author":"Parker\n              M,","year":"2011","unstructured":"Parker\n              M, \n            \n              Bowers\n              SP, \n            \n              Goldberg\n              RF, \n            \n              Pfluke\n              JM, \n            \n              Stauffer\n              JA, \n            \n              Asbun\n              HJ\n            \n            et al\n          . Transcervical videoscopic esophageal dissection during two-field minimally invasive esophagectomy: early patient experience. Surg Endosc2011;25(12):3865\u20133869"},{"issue":"4","key":"i0020-8868-100-4-580-b14","series-title":"Surgery","first-page":"504","article-title":"Mediastinoscopic esophagectomy using carbon dioxide insufflation via the neck approach","volume":"129","author":"Ikeda\n              Y,","year":"2001","unstructured":"Ikeda\n              Y, \n            \n              Niimi\n              M, \n            \n              Kan\n              S, \n            \n              Sasaki\n              Y, \n            \n              Shatari\n              T, \n            \n              Takami\n              H\n            \n            et al\n          . Mediastinoscopic esophagectomy using carbon dioxide insufflation via the neck approach. Surgery2001;129(4):504\u2013506"},{"issue":"4","key":"i0020-8868-100-4-580-b15","series-title":"Ann Thorac Surg","first-page":"1329","article-title":"Thoracoscopic esophagectomy combined with mediastinoscopy via the neck","volume":"73","author":"Ikeda\n              Y,","year":"2002","unstructured":"Ikeda\n              Y, \n            \n              Niimi\n              M, \n            \n              Kan\n              S, \n            \n              Takami\n              H, \n            \n              Kodaira\n              S.\n            \n          \n          Thoracoscopic esophagectomy combined with mediastinoscopy via the neck. Ann Thorac Surg2002;73(4):1329\u20131331"},{"key":"i0020-8868-100-4-580-b16","series-title":"J Robot Surg","first-page":"385","article-title":"Robotic-assisted totally transhiatal lymphadenectomy in the middle mediastinum for esophageal cancer","volume":"7","author":"Mori\n              K,","year":"2013","unstructured":"Mori\n              K, \n            \n              Yamagata\n              Y, \n            \n              Wada\n              I, \n            \n              Shimizu\n              N, \n            \n              Nomura\n              S, \n            \n              Seto\n              Y.\n            \n          \n          Robotic-assisted totally transhiatal lymphadenectomy in the middle mediastinum for esophageal cancer. J Robot Surg2013;7:385\u2013387"}],"container-title":["International Surgery"],"original-title":[],"link":[{"URL":"https:\/\/international-surgery.kglmeridian.com\/view\/journals\/insu\/100\/4\/article-p580.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/international-surgery\/article-pdf\/100\/4\/580\/2206423\/intsurg-d-14_00305_1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/international-surgery.kglmeridian.com\/downloadpdf\/journals\/insu\/100\/4\/article-p580.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/international-surgery.kglmeridian.com\/downloadpdf\/journals\/insu\/100\/4\/article-p580.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T19:00:29Z","timestamp":1751482829000},"score":1,"resource":{"primary":{"URL":"https:\/\/international-surgery.kglmeridian.com\/view\/journals\/insu\/100\/4\/article-p580.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,4]]},"references-count":16,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.9738\/intsurg-d-14.00305.1","relation":{},"ISSN":["0020-8868","2520-2456"],"issn-type":[{"value":"0020-8868","type":"print"},{"value":"2520-2456","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,4]]}}}