Abstract:

This article elucidates the procedures involved in lower mediastinal lymph node dissection via the right diaphragmatic crus approach.Initially， the abdominal esophagus was retracted caudally and ventrally.The diaphragmatic crus attachment of the esophagogastric junction was incised cranially along the right diaphragmatic crus.Subsequently， the air-containing loose space of the diaphragm-esophageal fascia was entered.The infra-cardiac bursa of the right lower mediastinum was gradually exposed， the infra-cardiac bursa was incised， and the lymph nodes of groups No.110 and No.112 were dissected along the pleura of the right mediastinum.The azygos vein was exposed dorsally， and the inferior pulmonary vein was exposed cranially.The infra-pulmonary vein was located dorsally and cranially.The dissection of group No.110 and No.112ao lymph nodes was continued cranially along the anterior fascia of the aortic， and the diaphragm was incised dorsally to ventrally to reveal group No.111 lymph nodes and adipose tissue anteriorly below the pericardium and resected.The esophagus was retracted to the right and caudally， and the No.112 Lpul group lymph nodes were cleared cranially along the left mediastinal pleura until the infra-pulmonary vein was revealed.Finally， the esophagus was denuded along the esophageal adventitia， and the lower mediastinal lymphatic and adipose tissues were excised in en-bloc.

Key words: Adenocarcinoma of esophagogastric junction, Laparoscopes, Radical dissection