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Surgical Case Reports
Fig. 6 | Surgical Case Reports

Fig. 6

From: Thoracoscopic esophagectomy with three-field lymphadenectomy for thoracic esophageal cancer in a patient with a double aortic arch: a report of a case

Fig. 6

a A concentric-structured model and surgical anatomy concerning the layer structure in the normal upper mediastinum. This anatomical model is based on human embryonic development. This is the essence of our surgical concept and practical anatomy. These figures are reproduced with permission from Fujiwara H, Kanamori J, Nakajima Y, Kawano T, Miura A, Fujita T, et al. An anatomical hypothesis: a “concentric-structured model” for the theoretical understanding of the surgical anatomy in the upper mediastinum required for esophagectomy with radical mediastinal lymph node dissection. Diseases of the esophagus: official journal of the International Society for Diseases of the Esophagus 2018 (Epub ahead of print) [12]. b The surgical anatomy of the upper mediastinum in patients with a double aortic arch, which we developed based on the concentric-structured model. We planned and performed the surgical procedure in this rare case while keeping in mind this theoretical surgical anatomy. AoA, aortic arch; BCA, brachiocephalic artery; CCA, common carotid artery; Eso, esophagus; PN, phrenic nerve; RLN, recurrent laryngeal nerve; SCA, subclavian artery; SNT, sympathetic nerve trunk; SVC, superior vena cava; TD, thoracic duct; Tra, trachea; VN, vagal nerve

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