Dissection with a metal dissector: a useful adjunct to transhiatal oesophagectomy

Asian J Surg. 2005 Apr;28(2):100-3. doi: 10.1016/S1015-9584(09)60271-2.


Objective: Intraoperative cardiovascular instability is frequently observed during blunt finger dissection for transhiatal oesophagectomy. We conducted a prospective study using a metal ring dissector for blunt dissection of the oesophagus to overcome this problem.

Methods: Dissection with a metal ring dissector was used in 30 consecutive patients undergoing transhiatal oesophagectomy for carcinoma of the lower oesophagus (n=26) and oesophagogastric junction (n=4).

Results: Dissection of the oesophagus proximal to the growth was quick and straightforward in all instances. The procedure appeared less traumatic than the conventional manual technique and was not associated with any intraoperative cardiovascular instability or intramediastinal bleeding. None of the patients had tracheal injury or recurrent laryngeal nerve paralysis. There was one anastomotic leak and no deaths.

Conclusion: Oesophageal blunt dissection with a metal ring dissector is safe, easy and quick. The correct plane of dissection minimizes the risk of intramediastinal bleeding and inadvertent trauma to neighbouring structures.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Cardiovascular Diseases / prevention & control
  • Dissection / instrumentation*
  • Equipment Design
  • Esophageal Neoplasms / surgery*
  • Esophagectomy / instrumentation*
  • Esophagectomy / methods
  • Humans
  • Intraoperative Complications / prevention & control
  • Middle Aged
  • Prospective Studies