PMC5293718_01
Computed tomography images.. Computed tomography images show a thick wall in the upper thoracic esophagus (a) and lymph node swelling in the dorsal area of the thoracic aorta (b).
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Computed tomography (CT) showed a thick wall in the upper esophagus and lymph node swelling around the bilateral recurrent laryngeal nerves and DTA (Fig. 1a, b).
Placement of the ports.. (1): A 5-mm port is placed in the 5th intercostal space along the middle axillary line (grasping forceps). (2): A 5-mm port is placed in the 7th intercostal space along the middle axillary line (operator's use). (3): A 12-mm port is placed in the 8th intercostal space along the posterior axillary line (assistant's use). (4): A 12-mm port is placed in the 9th intercostal space along the posterior axillary line (camera port).
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The procedure via the left side approach was performed using four ports (Fig. 2) to dissect around the DTA according to the preoperative navigation CT findings (Fig. 3a).
Images of case 1.. a: A preoperative three-dimensional computed tomography image shows the relationship between lymph node swelling in the dorsal area of the thoracic aorta and the neighboring structures.. b: A lymph node swelling in the cranial side of the dorsal area of the thoracic aorta (DTA) is removed using a left thoracoscopic procedure.. c: A lymph node swelling in the caudal side of the DTA is removed using a left thoracoscopic procedure.
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The thoracoscopic operational view is shown in Figs. 3b and c.
PMC5293718_02
Images of case 2.. a: A computed tomography image shows a thick wall in the esophagus and metastatic lymph node swelling in the dorsal area of the thoracic aorta (DTA).. b: A three-dimensional computed tomography image shows lymph node swelling in the DTA (arrows) and the course of left intercostal artery (arrow-head).. c: Left thoracoscopic intraoperative view. A metastatic lymph node in the DTA is dissected via the left thoracic cavity.
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CT showed a thick wall in the lower esophagus and lymph node swelling in the DTA (Fig. 4a). The lymph nodes in the DTA were dissected via the left thoracic cavity, and the intercostal arteries were identified using preoperative three-dimensional CT for reference (Figs. 4b, c).