Comparison of the perioperative outcome of esophagectomy by thoracoscopy in the prone position with that of thoracotomy in the lateral decubitus position

Abstract 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. Fifty-four of them underwent open thoracotomies in the left lateral decubitus position (Group O), 108 underwent thoracoscopic esophagectomy in the left lateral decubitus position (Group L) and 104 patients were treated by thoracoscopic esophagectomy in the prone position (Group P). Two patients in Group P, who presented with intra-operative bleeding and underwent thoracotomy, were subsequently excluded from the pulmonary function analysis. Results Two patients in Group P had to be changed from the prone position to the lateral decubitus position and underwent thoracotomy in order to control intra-operative bleeding. Despite the significantly longer chest operation period in Group P, total blood loss was significantly lower in this group when compared to Groups O and L. Furthermore, patients in Group P presented with significantly lower water balance during the perioperative period and markedly higher SpO2/FiO2 ratio after the surgery. The incidence of respiratory complications was significantly higher in Group O when compared to the other two groups; however, no significant differences were observed between the Groups L and P. Conclusion From a surgical point of view, artificial pneumothorax and gravity improves the operative field view in the prone position without any compression of the right lung, thereby resulting in no mechanical damage to the lungs. Prone position esophagectomy is a useful surgical technique, which appears to preserve the postoperative pulmonary function. The patients are able to endure the surgical procedure and present with less respiratory complications. Disclosure All authors have declared no conflicts of interest.

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Lateral decubitus digital subtraction myelography to identify spinal CSF–venous fistulas in spontaneous intracranial hypotension

Journal of Neurosurgery Spine ◽

10.3171/2019.6.spine19487 ◽

2019 ◽

Vol 31 (6) ◽

pp. 902-905 ◽

Cited By ~ 7

Author(s):

Wouter I. Schievink ◽

M. Marcel Maya ◽

Franklin G. Moser ◽

Ravi S. Prasad ◽

Rachelle B. Cruz ◽

...

Keyword(s):

Prone Position ◽

Intracranial Hypotension ◽

Spontaneous Intracranial Hypotension ◽

Lateral Decubitus Position ◽

Csf Leak ◽

Digital Subtraction ◽

Spinal Imaging ◽

Lateral Decubitus ◽

Venous Fistula ◽

Digital Subtraction Myelography

OBJECTIVESpontaneous spinal CSF–venous fistulas are a distinct type of spinal CSF leak recently described in patients with spontaneous intracranial hypotension (SIH). Using digital subtraction myelography (DSM) with the patient in the prone position, the authors have been able to demonstrate such fistulas in about one-fifth of patients with SIH in whom conventional spinal imaging (MRI or CT myelography) showed no evidence for a CSF leak (i.e., the presence of extradural CSF). The authors compared findings of DSM with patients in the lateral decubitus position versus the prone position and now report a significantly increased yield of identifying spinal CSF–venous fistulas with this modification of their imaging protocol.METHODSThe population consisted of 23 patients with SIH who underwent DSM in the lateral decubitus position and 26 patients with SIH who underwent DSM in the prone position. None of the patients had evidence of a CSF leak on conventional spinal imaging.RESULTSA CSF–venous fistula was demonstrated in 17 (74%) of the 23 patients who underwent DSM in the lateral decubitus position compared to 4 (15%) of the 26 patients who underwent DSM in the prone position (p < 0.0001). The mean age of these 16 women and 5 men was 52.5 years (range 36–66 years).CONCLUSIONSAmong SIH patients in whom conventional spinal imaging showed no evidence of a CSF leak, DSM in the lateral decubitus position demonstrated a CSF–venous fistula in about three-fourths of patients compared to only 15% of patients when the DSM was performed in the prone position, an approximately five-fold increase in the detection rate. Spinal CSF–venous fistulas are not rare among patients with SIH.

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Location of the Femoral Nerve in the Lateral Decubitus Versus Prone Position

Global Spine Journal ◽

10.1177/21925682211049170 ◽

2021 ◽

pp. 219256822110491

Author(s):

Ram Alluri ◽

Nicholas Clark ◽

Evan Sheha ◽

Karim Shafi ◽

Matthew Geiselmann ◽

...

Keyword(s):

Prone Position ◽

Interbody Fusion ◽

Femoral Nerve ◽

Psoas Muscle ◽

Lateral Decubitus Position ◽

Lumbar Plexus ◽

Lumbar Interbody Fusion ◽

Posterior Edge ◽

Disc Space ◽

Lateral Decubitus

Study Design Cadaveric study. Objective To compare the position of the femoral nerve within the lumbar plexus at the L4-L5 disc space in the lateral decubitus vs prone position. Methods Seven lumbar plexus specimens were dissected and the femoral nerve within the psoas muscle was identified and marked with radiopaque paint. Lateral fluoroscopic images of the cadaveric specimens in the lateral decubitus vs prone position were obtained. The location of the radiopaque femoral nerve at the L4-L5 disc space was normalized as a percentage of the L5 vertebral body (0% indicates posterior location and 100% indicates anterior location at the L4-L5 disc space). The location of the femoral nerve at L4-L5 in the lateral decubitus vs prone position was compared using a paired t test. Results In the lateral decubitus position, the femoral nerve was located 28% anteriorly from the posterior edge of the L4-L5 disc space, and in the prone position, the femoral nerve was relatively more posterior, located 18% from the posterior edge of the L4-L5 disc space ( P = .037). Conclusions The femoral nerve was on average more posteriorly located at the L4-L5 disc space in the prone position compared to lateral decubitus. This more posterior location allows for a larger safe zone at the L4-L5 disc space, which may decrease the incidence of neurologic complications associated with Lateral lumbar interbody fusion in the prone vs lateral decubitus position; however, further studies are needed to evaluate this possible clinical correlation.

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VS01.07: THORACOSCOPIC ESOPHAGECTOMY WITH A HYBRID OF THE PRONE AND LEFT LATERAL DECUBITUS POSITIONS FOR ESOPHAGEAL CARCINOMA

Diseases of the Esophagus ◽

10.1093/dote/doy089.vs01.07 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 45-45

Author(s):

Hirofumi Kawakubo ◽

Shuhei Mayanagi ◽

Yuko Kitagawa

Keyword(s):

Prone Position ◽

Conflicts Of Interest ◽

Invasive Procedure ◽

Massive Bleeding ◽

Lateral Decubitus Position ◽

Thoracoscopic Esophagectomy ◽

Operating Table ◽

Left Lateral Decubitus Position ◽

Artificial Pneumothorax ◽

Lateral Decubitus

Abstract Description Because esophagectomy with radical lymphadenectomy is highly invasive, thoracoscopic esophagectomy (TE) is attracting attention as a less invasive procedure. We first performed TE with the left decubitus position in 1996. In 2009 we developed a hybrid of the prone and left lateral decubitus positions for TE, and a total of 420 patients underwent TE with a hybrid position. We introduced TE with a hybrid position for the following three reasons: (1) Mobilization and lymphadenectomy around the middle and lower esophagus are easier in the prone position. Thanks to artificial pneumothorax and the gravity, the middle and lower mediastinum are opened, and which give us good surgical field. (2) Lymphadenectomy along the left recurrent laryngeal nerve (RLN) is more reliable and precise when performed in the left lateral decubitus position. We can dissect lymph node around the RLN higher position in the upper mediastinum. (3) Unexpected events requiring conversion to thoracotomy (e.g. massive bleeding, injury of other organs, dense intrathoracic adhesion, resection of adjacent organs) are easier to deal with in the left lateral decubitus position. The patient is fixed on the operating table with the semi-prone position and we can easily change patient positions from the left lateral decubitus position to the prone position and vice versa using rotation system of the operation table. The upper mediastinal procedure including lymphadenectomy along the right and left RLN is performed with the patient in the left lateral decubitus position, while the middle and lower mediastinal procedures are performed with the patient in the prone position with artificial pneumothorax (7mmHg). The abdominal procedures have beenwere performed by hand-assisted laparoscopic surgery (HALS) and gastric tube reconstruction in thethrough a posterior mediastinal route was performed as s a standard surgical procedure in our institution. The magnifying effect of thoracoscope enables us to perform more precise surgery and preserve nerve and vessels, and a hybrid position is thought to be feasible and effective methods. Disclosure All authors have declared no conflicts of interest.

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A hybrid of the prone and left lateral decubitus positions for thoracoscopic esophagectomy with extended LN dissection for esophageal squamous cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.402 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 402-402

Author(s):

Hirofumi Kawakubo ◽

Shuhei Mayanagi ◽

Satoru Matsuda ◽

Yuko Kitagawa

Keyword(s):

Prone Position ◽

Clinical Stage ◽

Operation Time ◽

Lateral Decubitus Position ◽

Thoracoscopic Esophagectomy ◽

Thoracic Esophagus ◽

Recurrent Nerve ◽

Number Of Patients ◽

Left Lateral Decubitus Position ◽

Lateral Decubitus

402 Background: We first performed thoracoscopic esophagectomy (TE) as a minimally invasive procedure with the left decubitus position in 1996. In 2009 we developed a hybrid of the prone and left lateral decubitus positions for TE with extended LN dissection (Extensive-TE). The patient is fixed with the semi-prone position and we can easily change patient positions from the left lateral decubitus position to the prone position using rotation system of the operation table. The upper mediastinal procedure including lymphadenectomy along the right and left recurrent laryngeal nerve (RLN) is performed with the patient in the left lateral decubitus position, while the middle and lower mediastinal procedures are performed with the patient in the prone position with artificial pneumothorax. Methods: ESCC patients who underwent Extensive-TE between January 2009 and December 2016, were retrospectively reviewed. The patients’ background, surgical outcomes, postoperative complications and recurrence-free survival (RFS) were studied. Results: Primary tumor was located in Cervical esophagus for 2 (1%), the upper-thoracic esophagus for 28 (15%), the mid-thoracic esophagus for 104 (54%) and the lower-thoracic esophagus for 57 (30%). Thenumber of patients classified with pre-treatment clinical stage of 1/2/3/4 was 94(49%)/42(22%)/46(24%)/9(5%), respectively. Eight patients were evaluated as having cM1 disease due to supraclavicular LN metastasis. The number of patients classified with postoperative pathological stage of 0/1/2/3/4 was 5(3%)/70(37%)/48(26%)/49(27%)/19(7%), respectively. The average total operation time was 542.1 and blood loss was 274.2. The incidence of postoperative pneumonia, anastomotic leakage, chylothorax, and recurrent nerve palsy was 17%, 14%, 2%, and 7% respectively. One patient died postoperatively within 90 days after surgery. Three years RFSwith clinical stage of 1/2/3+4 was 91.5%/54.8%/51.9%, respectively. Conclusions: The magnifying effect of thoracoscopy enables us to perform more precise surgery and preserve nerve and vessels. Extensive-TEwith a hybrid position is thought to be feasible and effective methods.

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Comparison of oxygenation during one lung ventilation in prone position with lateral decubitus position in esophagectomy

European Journal of Anaesthesiology ◽

10.1097/00003643-201006121-00316 ◽

2010 ◽

Vol 27 ◽

pp. 99

Author(s):

T. Yatabe ◽

M. Hirohashi ◽

K. Fukunaga ◽

K. Yamashita ◽

M. Yokoyama

Keyword(s):

Prone Position ◽

Lung Ventilation ◽

Lateral Decubitus Position ◽

One Lung Ventilation ◽

Lateral Decubitus

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Lumbar Puncture in the prone position for Low Birth Weight Neonates

BMC Pediatrics ◽

10.1186/s12887-021-03071-7 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Wanxu Guo ◽

Di Ma ◽

Min Qian ◽

Xiaoqi Zhao ◽

Jinpu Zhang ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Adverse Effects ◽

Success Rate ◽

Lumbar Puncture ◽

Prone Position ◽

Lateral Decubitus Position ◽

Standard Position ◽

Lateral Decubitus ◽

Position Group

Abstract Background Lumbar puncture in the lateral decubitus position will make the neonates uncomfortable and is likely to cause position change and unstable vital signs, and the application of sedative drugs will cause adverse effects. This study explored a novel method for lumbar puncture in the prone position for low weight neonates. Methods The neonates were randomly assigned into the standard position group receiving lumbar puncture in the lateral decubitus position; and the improved position group receiving lumbar puncture in the prone position. The success rate of first time attempts and the overall success rate of lumbar puncture, incidence of adverse effects, NIAPAS scores were collected and compared between these two groups. The difference in success rate and adverse effects incidence rate was analysed through Chi-square. Student’s t-test was used for the test of NIAPAS rating. Results The improved position group had a higher success rate of first attempt and overall success rate, significantly lower incidence of adverse effect and lower NIAPAS scores than those of the standard position group (P<0.05). Conclusion This lumbar puncture in the prone position is safer, more effective, and more comfortable for preterm neonates and those with low birth weight. Thus, this method is worth of further promotion. Trial registration Registration number, ChiCTR2100049923; Date of Registration, August 11, 2021; Retrospectively registered.

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