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Related Concept Videos

Esophageal Strictures-II: Clinical Features and Management01:26

Esophageal Strictures-II: Clinical Features and Management

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Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
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Esophageal Strictures-I: Introduction01:30

Esophageal Strictures-I: Introduction

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Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
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Esophageal Varices-I: Introduction01:24

Esophageal Varices-I: Introduction

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Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
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Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
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Barrett Esophagus-II: Clinical Manifestations and Management01:21

Barrett Esophagus-II: Clinical Manifestations and Management

735
Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
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Esophageal Perforation-I: Introduction01:22

Esophageal Perforation-I: Introduction

390
Esophageal perforation is a severe medical condition characterized by a breach in the integrity of the esophageal wall. This breach can occur due to various factors such as trauma, medical procedures, or underlying diseases. When the esophageal wall is compromised, it allows food, fluids, and digestive juices into the chest cavity or adjacent structures, leading to potential complications and health risks.
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
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Related Experiment Video

Updated: Jan 7, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
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The White Plane in Esophageal Surgery: A Novel Anatomical Landmark with Prognostic Significance.

Vladimir J Lozanovski1, Timor Roia1, Edin Hadzijusufovic1

  • 1Department of General, Visceral and Transplantation Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeck Str. 1, D-55131 Mainz, Germany.

Cancers
|December 30, 2025
PubMed
Summary

The white plane, an esophageal anatomical landmark, was visible in most robot-assisted minimally invasive esophagectomies. Identifying this white plane correlated with significantly longer overall survival in patients, though not impacting immediate complications.

Keywords:
Morosow’s ligamentchylothoraxda Vinci esophagectomyesophageal anatomyesophageal canceresophageal surgeryintraoperative landmarkminimally invasive surgeryrobot-assisted surgerysurgical anatomythoracic ductwhite plane

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Area of Science:

  • Surgical Anatomy
  • Minimally Invasive Surgery
  • Thoracic Surgery

Background:

  • Thoracic duct (TD) identification is crucial in esophageal surgery to prevent chylothorax.
  • The white plane (Morosow's ligament) is a consistent esophageal landmark with undefined clinical significance.

Purpose of the Study:

  • To assess the intraoperative visualization of the white plane during robot-assisted minimally invasive esophagectomy (RAMIE).
  • To evaluate the association between white plane visualization and patient outcomes, including survival and complications.

Main Methods:

  • Analysis of 166 patients undergoing RAMIE.
  • Documentation of intraoperative white plane visualization.
  • Assessment of patient demographics, tumor characteristics, complications (Clavien-Dindo), survival (Kaplan-Meier), and prognostic factors (Cox regression).

Main Results:

  • The white plane was visualized in 92.8% of patients.
  • No significant differences in postoperative complications or hospital stay between visualized and non-visualized groups.
  • Median overall survival was significantly longer in patients with a visualized white plane (43.1 vs. 13.1 months; p=0.0079).

Conclusions:

  • The white plane is a readily visualized intraoperative anatomical structure in RAMIE.
  • While its identification may aid TD recognition, its direct impact on surgical standardization and immediate outcomes requires further investigation.
  • Visualization of the white plane is associated with improved long-term overall survival.