Novel technique for lymphadenectomy along left recurrent laryngeal nerve during thoracoscopic esophagectomy

Figure 7 The bilateral pedicled nerve flap method. After the tissues were released from the edge of the trachea and left main bronchus, the anterior wall of the upper esophagus was completely mobilized from the trachea, with the left recurrent laryngeal nerve (RLN) and lymph nodes attaching to the upper esophagus. A: Then, a bilateral pedicled nerve flap, which was a two-dimensional membrane including the left RLN, peripheral LNs, and tracheoesophageal arteries, was exfoliated from the trachea; B: Subsequently, the “hollow-out” method was performed to transform the two-dimensional membrane into a three-dimensional structure, in which the left RLN, esophageal branches of the left RLN, lymph nodes and tracheoesophageal vessels could be easily identified. (1) Left RLN; (2) Lymph nodes along the left RLN; (3,4,7) Tracheoesophageal vessels; (5-6) Esophageal branches of the left RLN. RLN: Recurrent laryngeal nerve.