To avoid the inconvenience of triangulation among various rigid operating instruments in mediastinoscopy-assisted esophagectomy, we invented a new technique: used a flexible endoscope to mobilize thoracic esophagus and dissected mediastinal lymph nodes through the left cervical incision. This technology has not been reported so far. In this study, we introduce our long-term experience and demonstrate this new technique. Twenty-nine patients with early esophageal cancer underwent mediastinoscopy-assisted esophagectomy in our hospital from June 2018 to September 2020. Among them, 12 patients used flexible mediastinoscopy, and 17 patients used conventional rigid mediastinoscopy and instruments to observe their therapeutic effect. There were no significant differences between the two groups in gender, average age, body mass index, incidence of adverse reactions, bleeding volume, and postoperative hospital stay. The operation time of flexible mediastinoscopy group was significantly shorter than that of rigid mediastinoscopy group (192.9 ± 13.0 vs 246.8 ± 6.9 min, p < 0.01). The number of lymph nodes removed by flexible endoscopy was significantly more than that of rigid endoscopy (8.5 ± 0.6 vs 6.0 ± 0.3, P < 0.01). Postoperative follow-up was completed for all patients, and the average follow-up time was 11.6 ± 7.2 months. During the follow-up period, no recurrence or death was observed. Mediastinoscopy-assisted esophagectomy is an effective way to treat early esophageal cancer. The application of flexible mediastinoscopy provides more convenience and better stability. It can facilitate the operation of the surgeon and lymph node dissection, which proved to be a feasible technology.

中文翻译：

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硬、软纵隔镜在食管切除术中的应用：我们的经验和新技术

为避免纵隔镜辅助食管切除术中各种刚性操作器械之间三角测量的不便，我们发明了一种新技术：使用柔性内窥镜通过左侧颈部切口移动胸段食管并解剖纵隔淋巴结。该技术目前尚未见报道。在这项研究中，我们介绍了我们的长期经验并展示了这种新技术。2018年6月至2020年9月在我院接受纵隔镜辅助食管切除术的早期食管癌患者29例，其中软性纵隔镜12例，常规硬性纵隔镜及器械17例，观察治疗效果。两组在性别、平均年龄、体重指数、不良反应发生率、出血量和术后住院时间。软性纵隔镜组手术时间明显短于硬性纵隔镜组（192.9±13.0 vs 246.8±6.9 min，p < 0.01）。软性内镜切除淋巴结数量明显多于硬性内镜（8.5±0.6 vs 6.0±0.3，P < 0.01）。所有患者均完成术后随访，平均随访时间为11.6±7.2个月。随访期间未见复发或死亡。纵隔镜辅助食管切除术是治疗早期食管癌的有效方法。柔性纵隔镜的应用提供了更多的便利和更好的稳定性。它可以方便外科医生的操作和淋巴结清扫，