Utility of thoracic cage width in assessing surgical difficulty of minimally invasive esophagectomy in left lateral decubitus position

2019 ◽  
Vol 34 (8) ◽  
pp. 3479-3486 ◽  
Author(s):  
Shinsuke Takeno ◽  
Yukinori Tanoue ◽  
Rouko Hamada ◽  
Fumiaki Kawano ◽  
Kousei Tashiro ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Lateral Decubitus Position ◽  
Thoracic Cage ◽  
Invasive Esophagectomy ◽  
Left Lateral Decubitus Position ◽  
Surgical Difficulty ◽  
Lateral Decubitus

RA04.03: MINIMALLY INVASIVE ESOPHAGECTOMY IN THE LEFT LATERAL DECUBITUS POSITION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 25-25
Author(s):  
Koji Otsuka ◽  
Satoru Goto ◽  
Tomotake Ariyoshi ◽  
Takeshi Yamashita ◽  
Kentaro Motegi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Lymph Nodes ◽  
Anastomotic Leakage ◽  
Minimally Invasive Esophagectomy ◽  
Lateral Decubitus Position ◽  
Mediastinal Lymph Nodes ◽  
Invasive Esophagectomy ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus

Abstract Background We initially performed minimally invasive esophagectomy in a left lateral decubitus position through 5 ports in 1996, and we have now treated over 900 cases using this approach. This position has many benefits, but it also has some drawbacks. We were able to operate with good results after we introduced artificial pneumothorax with CO2 insufflation in 2010. We investigated the short- and long-term outcomes of thoracoscopic surgery for esophageal cancer in the left lateral decubitus position at our institution. Methods From 1996 to 2016, 807 esophageal cancer patients were treated with minimally invasive esophagectomy in the left lateral decubitus position at our hospital. We compared the 289 cases treated in the early period (1996–2005) and 518 cases treated in the late period (2006–2016), in which the procedure was standardized and operator training was established Results The completion rate of thoracoscopic surgery was 99.5%, with the procedure switched to thoracotomy in only 3 patients in whom hemorrhage occurred. The mean intrathoracic operative time was 205.0 min, mean intrathoracic blood loss was 127.3 mL, and mean number of dissected mediastinal lymph nodes was 24.7. The postoperative complications were pneumonia (8.5%), anastomotic leakage (7.5%), and recurrent nerve paralysis (7.8%). The 5-year overall survival rate was 69.5%. Comparison of 289 cases treated in the early period (1996–2005) and 518 cases treated in the late period (2006–2016), revealed significant differences in mean intrathoracic blood loss (174.0 vs. 94.2 mL); number of dissected mediastinal lymph nodes (20.0 vs. 28.4); postoperative hospital stay (33.4 vs. 20.0 days, all P < 0.001); and postoperative anastomotic leakage (13.9% vs. 1.6%, P < 0.0001). In recent operation, we do not have recurrent laryngeal nerve paralysis and hoarseness after we take care of the micro anatomical layer, stretch and thermal damage of recurrent laryngeal nerve when we dissect the lymph node. Conclusion These data indicate significant improvements in intrathoracic blood loss, number of dissected mediastinal lymph nodes, anastomotic leakage, and postoperative hospital stay, reflecting continued improvement of minimally invasive esophagectomy performed in the left lateral decubitus position at our institution. Disclosure All authors have declared no conflicts of interest.

Minimally invasive oesophagectomy in the prone versus lateral decubitus position: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Dimitrios Schizas ◽  
Dimitrios Papaconstantinou ◽  
Anastasia Krompa ◽  
Antonios Athanasiou ◽  
Tania Triantafyllou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Meta Analysis ◽  
Lateral Decubitus Position ◽  
Prone Positioning ◽  
Respiratory Complications ◽  
Invasive Esophagectomy ◽  
Postoperative Respiratory Complications ◽  
Lateral Decubitus

Abstract The thoracic phase of minimally invasive esophagectomy was initially performed in the lateral decubitus position (LDP); however, many experts have gradually transitioned to a prone position (PP) approach. The aim of the present systematic review and meta-analysis is to quantitatively compare the two approaches. A systematic literature search of the MEDLINE, Embase, Google Scholar, Web of Knowledge, China National Knowledge Infrastructure and ClinicalTrials.gov databases was undertaken for studies comparing outcomes between patients undergoing minimally invasive esophageal surgery in the PP versus the LDP. In total, 15 studies with 1454 patients (PP; n = 710 vs. LDP; n = 744) were included. Minimally invasive esophagectomy in the PP provides statistically significant reduction in postoperative respiratory complications (Risk ratios 0.5, 95% confidence intervals [CI] 0.34–0.76, P &lt; 0.001), blood loss (weighted mean differences [WMD] –108.97, 95% CI –166.35 to −51.59 mL, P &lt; 0.001), ICU stay (WMD –0.96, 95% CI –1.7 to −0.21 days, P = 0.01) and total hospital stay (WMD –2.96, 95% CI –5.14 to −0.78 days, P = 0.008). In addition, prone positioning increases the overall yield of chest lymph node dissection (WMD 2.94, 95% CI 1.54–4.34 lymph nodes, P &lt; 0.001). No statistically significant difference in regards to anastomotic leak rate, mortality and 5-year overall survival was encountered. Subgroup analysis revealed that the protective effect of prone positioning against pulmonary complications was more pronounced for patients undergoing single-lumen tracheal intubation. A head to head comparison of minimally invasive esophagectomy in the prone versus the LDP reveals superiority of the former method, with emphasis on the reduction of postoperative respiratory complications and reduced length of hospitalization. Long-term oncologic outcomes appear equivalent, although validation through prospective studies and randomized controlled trials is still necessary.

scholarly journals Surgical Benefits of Prone Position Thoracoscopic Esophagectomy Over Open Thoracic and Thoracoscopic Esophagectomy in Left Lateral Decubitus Position: A Literature Review

2020 ◽  
pp. 1-8
Author(s):  
Kazuo Koyanagi ◽  
Kazuo Koyanagi ◽  
Kentaro Yatabe ◽  
Miho Yamamoto ◽  
Soji Ozawa ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Lymph Nodes ◽  
Mediastinal Lymph Node ◽  
Minimally Invasive Esophagectomy ◽  
Node Dissection ◽  
Invasive Esophagectomy ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus

Objective: We reviewed the surgical outcomes of minimally invasive esophagectomy (MIE), especially the number of lymph nodes retrieved, for the patients with esophageal cancer to clarify the surgical benefits of MIE in patients with esophageal cancer. Material and Methods: A systematic literature search was performed, and articles that fully described the surgical results of MIE were selected. Parameters such as operative time, blood loss, the number of lymph nodes retrieved, and postoperative complications were compared among patients undergoing minimally invasive esophagectomy (MIE) in the left lateral decubitus position (MIE-LP), MIE in the prone position (MIE-PP), and open thoracic esophagectomy (OE). Results: The conversion rate from MIE to OE was very low. MIE-PP was associated with lower blood loss than OE and MIE-LP. Results of a multicenter randomized controlled trial demonstrated that pneumonia and recurrent laryngeal nerve paralysis in MIE-PP significantly reduced compared with OE. Although postoperative complications were not different between MIE-PP and MIE-LP, the number of lymph nodes retrieved in MIE-PP was higher than that in MIE-LP. Conclusion: MIE-PP has potential benefits in terms of less surgical invasiveness and improvement of mediastinal lymph node dissection. A prospective randomized control trial using a large number of cases and long-term follow-up is recommended for analyses of appropriate mediastinal lymph node dissection and its impact on oncological benefit.

Minimally invasive esophagectomy: Lateral decubitus vs. prone positioning; systematic review and pooled analysis

2015 ◽  
Vol 24 (3) ◽  
pp. 212-219 ◽  
Author(s):  
Sheraz R. Markar ◽  
Tom Wiggins ◽  
Stefan Antonowicz ◽  
Emmanouil Zacharakis ◽  
George B. Hanna
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Pooled Analysis ◽  
Prone Positioning ◽  
Invasive Esophagectomy ◽  
Lateral Decubitus

Surgical Techniques for Thoracoscopic Esophagectomy at the Left Lateral Decubitus Position

2019 ◽  
Vol 70 (2) ◽  
pp. 197-197
Author(s):  
H. Sato ◽  
Y. Miyawaki ◽  
N. Fujiwara ◽  
H. Sugita ◽  
M. Aikawa ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Lateral Decubitus Position ◽  
Thoracoscopic Esophagectomy ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus

scholarly journals European consensus on essential steps of Minimally Invasive Ivor Lewis and McKeown Esophagectomy through Delphi methodology

2021 ◽  
Author(s):  
Yassin Eddahchouri ◽  
◽  
Frans van Workum ◽  
Frits J. H. van den Wildenberg ◽  
Mark I. van Berge Henegouwen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Expert Panel ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Round Table Discussion ◽  
Ivor Lewis ◽  
Delphi Methodology ◽  
Invasive Esophagectomy ◽  
European Consensus ◽  
Mckeown Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure with a long learning curve, which is associated with increased morbidity and mortality. To master MIE, training in essential steps is crucial. Yet, no consensus on essential steps of MIE is available. The aim of this study was to achieve expert consensus on essential steps in Ivor Lewis and McKeown MIE through Delphi methodology. Methods Based on expert opinion and peer-reviewed literature, essential steps were defined for Ivor Lewis (IL) and McKeown (McK) MIE. In a round table discussion, experts finalized the lists of steps and an online Delphi questionnaire was sent to an international expert panel (7 European countries) of minimally invasive upper GI surgeons. Based on replies and comments, steps were adjusted and rephrased and sent in iterative fashion until consensus was achieved. Results Two Delphi rounds were conducted and response rates were 74% (23 out of 31 experts) for the first and 81% (27 out of 33 experts) for the second round. Consensus was achieved on 106 essential steps for both the IL and McK approach. Cronbach’s alpha in the first round was 0.78 (IL) and 0.78 (McK) and in the second round 0.92 (IL) and 0.88 (McK). Conclusions Consensus among European experts was achieved on essential surgical steps for both Ivor Lewis and McKeown minimally invasive esophagectomy.

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