421. unveiling the complexity—dissection of 106 lymph nodes in esophageal cancer

Abstract https://drive.google.com/file/d/1mKXEdCEEyOmzHo0bWJoRs4qAUDpr3LAk/view Background Surgical resection with thoracic lymphadenectomy is currently the sole curative option for treating non-cervical esophageal cancer. While a minimally invasive approach can achieve an efficient lymphadenectomy with reduced morbidity, its intricate and complex technical nature has limited its routine utilization in many centers. We aim to present a step-by-step approach to thoracoscopic thoracic lymphadenectomy. Methods Our upper gastrointestinal unit has developed multiple training protocols to create an optimal learning environment that aims to enhance surgical comprehension. Video coaching is a fundamental component of this learning environment, effectively demonstrating and deconstructing intricate surgical procedures. In recognition of the importance of minimally invasive thoracic lymphadenectomy, we have developed a video that is now incorporated into our existing curriculum. The video coaching and debriefing process enables us to continuously refine and optimize our training protocols, ultimately reducing the learning curve. Results We present a video showcasing a systematic and minimally invasive approach to total thoracic lymphadenectomy. This video offers a comprehensive overview of the key anatomical landmarks that require identification during the procedure, the sequential steps involved, and the critical pitfalls. Additionally, it provides valuable insights into the recognition of these landmarks and emphasizes the significance of 3D visualization of the ganglionic station for a better understanding of this procedure. Furthermore, the long-form video presentation will include additional correlation with the patient’s CT scans for a more in-depth comprehension of the procedure. Conclusion In high-volume centers that utilize a standardized technique, thoracoscopic total thoracic lymphadenectomy for esophageal cancer can be performed in a safe and reproducible manner with minimal morbidity. The use of a minimally invasive approach not only provides optimal anatomical visualization but also facilitates video revision and debriefing of the surgeries, ultimately improving the understanding of this complex surgical procedure.