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Prone position esophagectomy

Federico Marchesi, Chiara Rapacchi, Vittoria Pattonieri, Francesco Tartamella, Maria Teresa Mita, Stefano Cecchini
Refractory esophageal strictures are a common sequela of caustic ingestion. If endoscopic dilation becomes ineffective, esophagectomy represents the only therapeutic option. The minimally invasive approach, specifically the thoracoscopic access in prone position, may allow postoperative morbidity to be reduced. We present the first case described in the Literature of minimally invasive esophagectomy in prone position for a long-term failure of endoscopic dilation after caustic ingestion.
2016: Acta Bio-medica: Atenei Parmensis
Manila Singh, Rajeev Uppal, Kapil Chaudhary, Amit Javed, Anil Aggarwal
Minimally invasive and hybrid minimally invasive esophagectomy (MIE) is a technically challenging procedure. Anesthesia for the same is equally challenging due to special requirements of the video-assisted thoracoscopic technique used and shared operative and respiratory fields. Standard ventilatory strategy for this kind of surgery has been 1-lung ventilation with the help of a double-lumen tube. Prone positioning for thoracoscopic dissection facilitates gravity-dependant collapse of the operative side lung induced by a unilateral capnothorax, thus making the use of single-lumen endotracheal tube a feasible option for this surgery...
September 2016: Journal of Clinical Anesthesia
Taro Oshikiri, Tetsu Nakamura, Yukiko Miura, Masashi Yamamoto, Shingo Kanaji, Kimihiro Yamashita, Takeru Matsuda, Yasuo Sumi, Satoshi Suzuki, Yoshihiro Kakeji
BACKGROUND: In esophageal squamous cell carcinoma, the number of dissected lymph nodes (LNs), including those along the recurrent laryngeal nerves (RLNs), influences prognosis and nodal staging accuracy. However, dissection of LNs along the RLN increases the risk of complications, especially RLN palsy. Therefore, complete dissection of these LNs with prevention of RLN palsy is recommended. We present herein a new method for lymphadenectomy along the right RLN, named the Pincers maneuver, during thoracoscopic esophagectomy in the prone position (TEP)...
August 4, 2016: Surgical Endoscopy
Taro Oshikiri, Takashi Yasuda, Masashi Yamamoto, Shingo Kanaji, Kimihiro Yamashita, Takeru Matsuda, Yasuo Sumi, Tetsu Nakamura, Yasuhiro Fujino, Masahiro Tominaga, Satoshi Suzuki, Yoshihiro Kakeji
PURPOSE: Minimally invasive esophagectomy (MIE) has less morbidity than the open approach. In particular, thoracoscopic esophagectomy in the prone position (TEP) has been performed worldwide. Using the cumulative sum control chart (CUSUM) method, this study aimed to confirm whether a trainee surgeon who learned established standards would become skilled in TEP with a shorter learning curve than that of the mentoring surgeon. METHODS: Surgeon A performed TEP in 100 patients; the first 22 patients comprised period 1...
September 2016: Langenbeck's Archives of Surgery
Hirokazu Noshiro
Conventional thoracotomic esophagectomy has been performed for treating invasive thoracic esophageal carcinoma. In spite of the improved survival rate, the procedure is associated with significant operative morbidity and mortality rates due to the extreme invasiveness of an extensive dissection for the lymph nodes. Minimally invasive esophagectomy was developed to reduce surgical invasiveness. Recently, the use of thoracoscopic esophagectomy performed in the prone position has stimulated new interest in minimally invasive approaches...
July 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Taro Oshikiri, Takashi Yasuda, Hiroshi Hasegawa, Masashi Yamamoto, Shingo Kanaji, Kimihiro Yamashita, Takeru Matsuda, Yasuo Sumi, Tetsu Nakamura, Yasuhiro Fujino, Masahiro Tominaga, Satoshi Suzuki, Yoshihiro Kakeji
PURPOSE: Thoracoscopic esophagectomy with the patient in the prone position (TEP) is now being performed as minimally invasive esophagectomy for esophageal cancer. This study examines the short-term outcomes and the learning curve associated with TEP. METHODS: One surgeon ("Surgeon A") performed TEP on 100 consecutive patients assigned to three periods based on treatment order. Each group consisted of 33 or 34 patients. The outcomes of the three groups were compared to define the influence of surgeon expertise...
July 11, 2016: Surgery Today
Dai Otsubo, Tetsu Nakamura, Masashi Yamamoto, Shingo Kanaji, Kiyonori Kanemitsu, Kimihiro Yamashita, Tatsuya Imanishi, Taro Oshikiri, Yasuo Sumi, Satoshi Suzuki, Daisuke Kuroda, Yoshihiro Kakeji
BACKGROUND: While thoracoscopic esophagectomy is a widely performed surgical procedure, only few studies regarding the influence of body position on changes in circulation and breathing, after the surgery, have been reported. This study aimed at evaluating the effect of body position, during surgery, on the postoperative breathing functions of the chest. METHODS: A total of 266 patients who underwent right-sided transthoracic esophagectomy for esophageal cancer from 2004 to 2012 were included in this study...
July 7, 2016: Surgical Endoscopy
Hiroyuki Daiko, Takeo Fujita
No abstract text is available yet for this article.
March 2016: Nihon Geka Gakkai Zasshi
Hiroyuki Kitagawa, Tsutomu Namikawa, Masaya Munekage, Kazune Fujisawa, Eri Munekgae, Michiya Kobayashi, Kazuhiro Hanazaki
PURPOSE: The aim of this study was to evaluate the short- and long-term outcomes of thoracoscopic esophagectomy performed in the prone position (TSE-PP) followed by laparoscopic gastric mobilization (LGM) compared with open thoracotomy and LGM, for esophageal cancers. METHODS: We reviewed the records of 105 consecutive patients who underwent esophagectomy with LGM for esophageal cancer at Kochi Medical School. Among the study patients, 60 patients underwent TSE-PP, while 45 underwent open thoracotomy (OPEN group)...
August 2016: Langenbeck's Archives of Surgery
Koichi Suda, Masaya Nakauchi, Kazuki Inaba, Yoshinori Ishida, Ichiro Uyama
Minimally invasive surgery (MIS) for upper gastrointestinal (GI) cancer, characterized by minimal access, has been increasingly performed worldwide. It not only results in better cosmetic outcomes, but also reduces intraoperative blood loss and postoperative pain, leading to faster recovery; however, endoscopically enhanced anatomy and improved hemostasis via positive intracorporeal pressure generated by CO2 insufflation have not contributed to reduction in early postoperative complications or improvement in long-term outcomes...
May 21, 2016: World Journal of Gastroenterology: WJG
Tetsuya Abe, Ryosuke Kawai, Norihisa Uemura, Jiro Kawakami, Seiji Ito, Koji Komori, Yoshiki Senda, Kazunari Misawa, Masayuki Shinoda, Yasuhiro Shimizu
A 69-year-old man who had undergone an esophagectomy was diagnosed with chylous leakage on postoperative day 2, and his pleural effusion output gradually increased daily. On postoperative day 6, intranodal lymphangiography using lipiodol demonstrated chylous leakage from branches of an incomplete duplicated left-sided thoracic duct; it also indicated successful ligation of the right-sided thoracic duct at initial operation. After lymphangiography, the chylous leakage did not heal and remained uncontrollable...
May 2016: Asian Journal of Endoscopic Surgery
T Fujita, N Okada, J Kanamori, T Sato, S Mayanagi, K Torigoe, A Oshita, H Yamamoto, H Daiko
Minimally invasive thoracoscopic esophagectomy has potential advantages in minimizing the impairment of respiratory function and reducing surgical stress. However, thoracoscopic esophagectomy occasionally results in anesthesia-induced hypothermia, particularly in cases involving artificial pneumothorax with CO2 . Thermogenesis induced by amino acid administration has been reported during anesthesia. Here, we tested the efficacy of amino acid treatment for the prevention of hypothermia, and we investigated the potential of this treatment to reduce postoperative infectious complications after thoracoscopic esophagectomy...
March 22, 2016: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
Tomoyuki Irino, Jon A Tsai, Jessica Ericson, Magnus Nilsson, Lars Lundell, Ioannis Rouvelas
PURPOSE: Minimally invasive esophagectomy (MIE) has been met with increased interest for the surgical treatment of esophageal cancer. One critical obstacle for the implementation of MIE has been the intrathoracic anastomosis. In this study, we describe a technique of thoracoscopic intrathoracic anastomosis using a linear stapler in prone position and present the short-term outcomes of this procedure. METHODS: This prospective pilot study included 46 consecutive patients with a cancer either of the gastroesophageal junction (GEJ) or the distal esophagus who underwent either total MIE or thoracoscopic-assisted esophagectomy followed by intrathoracic stapled side-to-side anastomosis...
May 2016: Langenbeck's Archives of Surgery
Shao-hui Zhou, Yong-bin Song, Li-jun Liu, Hong-shang Cui
BACKGROUND: Total thoracoscopic and laparoscopic esophagectomy (TLE) has attracted attention with the advantage of better operative field and minimal wound for the esophageal cancer. However, various severe complications are also reported during the TLE such as cervical anastomotic leakage, chylothorax, and tracheal injury. The aim of this study was to introduce a new optimized TLE procedure for the esophageal cancer and assess its safety and clinical effects. METHODS: We retrospectively collected the clinical data of 30 patients with esophageal cancer who underwent optimized TLE procedures between January 2014 and December 2014...
2016: World Journal of Surgical Oncology
Masayuki Honda, Hiroyuki Daiko, Takahiro Kinoshita, Takeo Fujita, Hidehito Shibasaki, Toshiro Nishida
We report on a case of synchronous carcinomas of the esophagus and stomach. A 68-year-old man was referred to our hospital for an abnormality found during his medical examination. Further evaluation revealed squamous cell carcinoma in the thoracic lower esophagus and gastric adenocarcinoma located in the middle third of the stomach. Thoracoscopic esophagectomy in the prone position (TSEP), laparoscopic total gastrectomy (LTG) with three-field lymph node dissection, and laparoscopically assisted colon reconstruction (LACR) were performed...
December 2015: Surgical Case Reports
Yong Xi, Zhenkai Ma, Yaxing Shen, Hao Wang, Mingxiang Feng, Lijie Tan, Qun Wang
BACKGROUND: Due to limited space in the left upper mediastinum, complete dissection of lymph nodes (LN) along left recurrent laryngeal nerve (RLN) is difficult. We herein present a novel method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position for esophageal carcinoma. The method, suspension the esophagus and push aside trachea, allows en bloc lymphadenectomy along the left RLN from the below aortic arch to the thoracic inlet. METHODS: Between September 2014 and September 2015, a total of 110 consecutive patients with esophageal carcinoma were treated with thoraco-laparoscopic esophagectomy with cervical anastomosis in the semi-prone position...
January 2016: Journal of Thoracic Disease
Xu Li, Fan-Cai Lai, Min-Lian Qiu, Rong-Gang Luo, Jian-Bo Lin, Bo Liao
BACKGROUND: An open esophagectomy for esophageal cancer is a severely invasive procedure. Minimally invasive esophagectomy (MIE) has emerged as an effective alternative to open techniques. Conventionally, a thoracoscopic procedure is performed either in the left lateral decubitus position or in the prone position. Both positions have their disadvantage during the mobilization of the esophagus. In this study, we applied a novel position: the left lateral-prone position in the throacoscopic phase of MIE; we also describe the details of the technique and its feasibility, and present the initial results of this large-volume series...
February 2016: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
H Noshiro, Y Yoda, M Hiraki, H Kono, S Miyake, A Uchiyama, E Nagai
Patients with thoracic esophageal cancer are often treated by minimally invasive esophagectomy. However, the long-term survival benefits of minimally invasive esophagectomy remain unclear. Two approaches are available for thoracoscopic surgery: one with the patient in the left lateral decubitus position (LLDP), and the other with the patient in the prone position (PP). We investigated the survival benefit of thoracoscopic esophagectomy according to the tumor stage and patient position during the thoracoscopic procedure...
November 6, 2015: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
Shinichiro Tanaka, Takayuki Kawakami, Toru Ehara, Yoshihiro Hirabayashi
We report anesthetic management of patients undergoing single-lumen tracheal tube ventilation with artificial pneumothorax in thoracolaparoscopic esophagectomy in prone position. No adverse effect against respiratory and circulatory management was found during esophagectomy. Single-lumen tracheal tube ventilation with artificial pneumothorax potentially is a feasible method for thoracolaparoscopic esophagectomy in prone position.
September 2015: Masui. the Japanese Journal of Anesthesiology
Stefano Bongiolatti, Mario Annecchiarico, Michele Di Marino, Bernardo Boffi, Sara Borgianni, Alessandro Gonfiotti, Luca Voltolini, Andrea Coratti
INTRODUCTION: Robot-assisted minimally invasive esophagectomy with intra-thoracic anastomosis showed encouraging results but there is a lack of data to demonstrate the safety and feasibility. OBJECTIVE: The aim of this study is to report our experience in RA-ILE (robotic-assisted Ivor-Lewis esophagectomy) with robotic hand-sewn anastomosis. METHODS: This is a retrospective study of patients who underwent robotic-assisted esophagectomy in prone position with intrathoracic anastomosis for malignant neoplasm of the esophagus or esophago-gastric junction...
September 2016: International Journal of Medical Robotics + Computer Assisted Surgery: MRCAS
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