A new technique for substernal colon transposition with a breast dissector: report of 39 cases

This paper investigates the effectiveness of the breast dissector to create a substernal space for oesophageal reconstruction. The surgeon must be extremely careful while dissecting the tissue below the sternum in order to avoid pneumothorax. The endoscopically assisted preparation of the substernal route is safe but it requires appropriate training. A retrospective study on 68 patients who underwent oesophageal reconstruction was done analysing the patients' records. In 39 cases, the breast dissector was used. In 29 cases, the substernal tunnel was created with hand dissection only. All 68 colon segments were successfully transferred in the two groups of patients. In all 39 the cases where the breast dissector was used no pneumothorax followed. In 10 (34%) patients of the control group pneumothorax occurred. Concluding, no more pneumothorax has occurred during the substernal oesophageal reconstruction since we started using the breast dissector.