STEP 3Endodissection mediastinoscopic anterior view

The retrotracheal tissues are divided by pushing the tissue with the coagulation/suction device followed by the application of a short "coagulation" impulse or dissection with ultrasonic shears.

The anterior surface of the esophagus is subsequently dissected until 2-3cm below the tracheal bifurcation.

We usually identify the left recurrent nerve, both vagal trunks, the tracheal bifurcation and the subcarinal lymph nodes, which can be removed in toto.

By turning the tip of the instrument counterclockwise by 90 degrees, the left surface of the esophagus can be dissected. This is usually the most difficult part of endodissec-tion due to adhesions between esophagus and the left main bronchus. These must be totally divided. Care has to be taken not to divide the longitudinal muscle layer of the esophagus at this point.

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