PMC5337371_01
(a) Distal part of the gastric tube. (b) Endoscopic view of the dissection from the ventral side. (c) Neck incision and right chest thoracoscopic port.
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Seromuscular sutures were placed on the stump of the duodenum (Figure 1(a)). However, these surfaces were relatively safe to dissect, as they could be done so with an ultrasonic coagulation-cutting device while observing the dissection endoscopically to ensure no intraluminal violation (Figure 1(b)). Therefore, when approximately two-thirds of the dissection was complete, a thoracoscopic port was inserted in the right chest in an intercostal space (Figure 1(c)).
(a) Adhesion between the pericardium and the staple line of the gastric tube (black arrow). (b) Adhesion between the back surface of the sternum and the omentum. (c) Superior vena cava (black arrow) and left brachiocephalic vein (white arrow). (d) Right internal mammary vein (black arrow).
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The adhesions were most dense on the anterior and posterior surfaces of the mediastinum (Figure 2(a)). The pericardium could be adherent to the staple line of the gastric tube posteriorly (Figure 2(b)). The superior vena cava, brachiocephalic vein, and internal mammary vein were all located in the upper mediastinum (Figure 2(c)). It was also critical to be mindful of the internal mammary vein branching off from brachiocephalic vein (Figure 2(d)).