263 MEDIASTINAL LYMPHADENECTOMY UNDER LAPAROSCOPIC ASSISTED SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Xiangfeng Gan ◽  
Xiaojian Li ◽  
Qingdong Cao
Keyword(s):  
Single Port ◽  
Main Bronchus ◽  
Minimally Invasive Esophagectomy ◽  
Surgical Techniques ◽  
Lower Edge ◽  
Mediastinal Lymphadenectomy ◽  
Invasive Esophagectomy ◽  
Surgical Methods ◽  
Left Neck ◽  
The Right

Abstract   Minimally invasive esophagectomy (MIE) has developed for decades. However, conventional MIE requires transthoracic operation, it could increase the risk of many perioperative cardiopulmonary complications. Therefore, mediastinoscopy-assisted transhiatal esophagectomy has been proposed, but the traditional surgical methods have shortcomings, such as unclear vision, especially during the dissection of mediastinal lymph nodes. A new approach of mediastinal lymphadenectomy under single-port inflatable mediastinoscopy through one left-neck incision was proposed. Methods With pneumomediastinum, esophagectomy was to be performed over the aortic arch to the level of lower edge of the left main bronchus, and the lymphadenectomy of 106recL has also accomplished during this process. At the level of lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, the instruments could get accessed to the right RLN. The lymphadenectomy could get accomplished up to 2-cm at the upper edge of the RSA. Between the trachea and esophagus, the lymphadenectomy of 107 would be performed along the trailing edge of the trachea down to the carina. Results 56 patients with esophageal squamous cell carcinoma from March to September 2019 who underwent this operation. The mean age of 56 patients was 67.4 years, 46 were males, and 10 were females. Preoperative TNM staging: T1b, 10 cases; T2, 35 cases; and T3, 11 cases. The median number of mediastinal LNs removed was 17 (9 to 23); 6 (2 to 9) along the left RLN; 3 (1 to 6) along the right RLN. 7 patients (12.5%) developed RLN palsy. All of the 7 RLN palsy were left side, none of them appeared at 3-month postoperation. Conclusion This single-port inflatable mediastinoscopy technology could remove the upper mediastinal LNs on both sides with a single incision on the left neck, avoid trauma to the right neck. The bilateral RLN could be clearly exposed and protected under the mediastinoscopy. Compared with previous surgical techniques, this surgery is less invasive, and the bilateral RLN is more clearly revealed. The surgical procedure described here is the first mediastinal lymphadenectomy under mediastinoscopy through one single left-neck incision. Video https://www.jianguoyun.com/p/DUvIaIsQoPWPBhj1mt8C.

270 LYMPHADENECTOMY ALONG BILATERAL RECURRENT LARYNGEAL NERVE UNDER SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
X Wu ◽  
X Gan ◽  
Q Cao
Keyword(s):  
Minimally Invasive ◽  
Recurrent Laryngeal Nerve ◽  
Minimally Invasive Esophagectomy ◽  
Cell Cancer ◽  
Laryngeal Nerve ◽  
Lower Edge ◽  
Invasive Esophagectomy ◽  
Surgical Methods ◽  
Left Neck ◽  
The Right

Abstract   Mediastinal lymphadenectomy is a crucial part of minimally invasive esophagectomy, and requires transthoracic operation, which is a crucial independent risk factor for the incidence of pulmonary complications. Conventionally, non-transthoracic esophagectomy was often achieved by mediastinoscope-assisted laparoscopic transhiatal surgery. Because of the small space, the lymphadenectomy could be only performed partially under mediastinoscope in upper mediastinal. We propose a new approach of lymphadenectomy along bilateral recurrent laryngeal nerve under mediastinoscopy through one left-neck incision. Methods A 3-cm incision paralleling the clavicle was made at 2-cm from the supraclavicular region in the left neck. After established pneumomediastinum (10-12 mmHg carbon dioxide), esophagectomy begins to perform over the aortic arch to the level of lower edge of the left main bronchus, and the lymphadenectomy along the left RLN has also accomplished during this process. At the level of lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, the instruments could get accessed to the right RLN. The lymphadenectomy could get accomplished up to 2-cm at the upper edge of the RSA. Results The mean age of 56 esophageal squamous cell cancer patients was 67.4 years, 46 males and 10 females. Tumor location: middle thoracic, 31 patients, lower thoracic, 23 patients. Preoperative TNM staging: T1b was 10 cases, T2 was 35 cases, and T3 was 11 cases. The median number of mediastinal LNs removed was 17 (9 to 23); 6 (2 to 9) along the left RLN; 3 (1 to 6) along the right RLN. 7 patients (12.5%) developed RLN palsy. Postoperative laryngoscopy showed that all of the 7 RLN palsy were left side, none of them appeared at 3 months postoperation. Conclusion This approach enables the lymphadenectomy along bilateral RLN through one left neck incision. During the operation, the upper mediastinal LNs along the bilateral RLN were clearly revealed and en bloc excised. Meanwhile, the bilateral RLN were fully exposed and protected during the procedure. Compared with the previous surgical methods,this procedure is less invasive, and the bilateral RLN could be exposed much clearer. It would provide a novel approach for the minimally invasive esophagectomy, especially lymphadenectomy.

770 CONSIDERABLE EFFECT OF UPPER MEDIASTINAL LYMPHADENECTOMY UNDER LAPAROSCOPIC ASSISTED SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Xiaojin Wang ◽  
Xiangfeng Gan ◽  
Qingdong Cao
Keyword(s):  
Perioperative Complications ◽  
Membrane Damage ◽  
Operation Time ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Mediastinal Lymphadenectomy ◽  
Invasive Esophagectomy ◽  
Anastomotic Strictures ◽  
Left Neck ◽  
The Right

Abstract   Conventional minimally invasive esophagectomy requires transthoracic surgery, which could increase the risk of many perioperative complications. Mediastinoscopy-assisted transhiatal esophagectomy has been proposed for years, but the traditional methods have shortcomings, such as unclear vision, especially during the dissection of upper mediastinal lymph nodes. We proposed a novel approach of upper mediastinal lymphadenectomy with mediastinoscopy through a left-neck incision, and investigated the effect of lymphadenectomy and other perioperative outcomes. Methods This approach for upper mediastinal lymphadenectomy includes three parts. (I) Lymphadenectomy along the left recurrent laryngeal nerve (RLN) could be accomplished during esophagectomy under mediastinoscopy. (II) At the level of the lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, instruments are used to access the right RLN. Lymphadenectomy of up to 2 cm could be accomplished at the upper edge of the RSA. (III) Between the trachea and esophagus, the left and right main bronchi are exposed along the trailing edge of the trachea down to the carina, and lymphadenectomy can be performed here. Results This lymphadenectomy had been completed successfully on 117 patients, and 1 was converted to thoracotomy due to intraoperative tracheal membrane damage. The average operation time was 181.4 ± 43.2 minutes, bleeding volume was 106.4 ± 87.9 mL. The number of dissected LNs of upper mediastinal, the left RLN, the right RLN and the subcarinal was 11.2 ± 6.3, 5.1 ± 2.8, 3.2 ± 1.3 and 3.8 ± 2.1 respectively. 10 cases of (8.5%) anastomotic fistula were resolved with proper drainage and nutritional support. There were 25 cases (21.2%) of anastomotic strictures, 10 cases (8.5%) of pleural effusion, 20 cases (16.9%) of hoarseness. The incidence of hoarseness was 2.5% in three months postoperation. Conclusion These results showed that the lymphadenectomy through the left neck approach was not inferior than other surgical approaches in the amount of upper mediastinal LNs resection and perioperative outcome. Further research is needed to discover its impact on the long-term prognosis of ESCC patients.

9 SURGICAL TECHNIQUES AND POTENTIAL OF MEDIASTINAL LYMPHADENECTOMY IN ROBOTIC SURGERY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Taro Oshikiri ◽  
Gosuke Takiguchi ◽  
Naoki Urakawa ◽  
Hiroshi Hasegawa ◽  
Masashi Yamamoto ◽  
...  
Keyword(s):  
Health Insurance ◽  
Robotic Surgery ◽  
Minimally Invasive Esophagectomy ◽  
Surgical Techniques ◽  
Laryngeal Nerve ◽  
The Other ◽  
Robot Assisted ◽  
Mediastinal Lymphadenectomy ◽  
Invasive Esophagectomy ◽  
Grade Ii

Abstract   Procedure of minimally invasive esophagectomy in prone position (Conventional prone-MIE) is standardized leading to feasible short outcomes. On the other hand, robot assisted MIE (Robotic MIE) was approved as Japanese health insurance treatment since 2018. Especially, reduction of recurrent laryngeal nerve (RLN) palsy leading to aspiration pneumonia is expected for Robotic MIE. The purpose of this study is to clarify the potential of Robotic MIE for improvement of short outcomes. Methods Twenty-four Robotic MIEs in introduction period since 2018 and 128 Conventional prone-MIEs in established period since 2015 from all of the 375 cases were compared using propensity score matching. Results Operative times in both entire and thoracic procedures were significantly longer in Robotic MIE. There were no significant differences between two groups in the number of harvested lymph nodes, amount of the blood loss, left RLN palsy rate (13% vs 14%, > Clavien-Dindo classification: C-D grade I), right RLN palsy rate (4% vs 8%, > C-D grade I), and pneumonia rate (7% vs 7%, > C-D grade II). Conclusion Short outcomes of Robotic MIE in introduction period were not inferior to those of Conventional prone-MIE in established period. More improvement is expected for Robotic MIE via learning curve. In conclusion, Robotic MIE has hidden potential to outstrip Conventional prone-MIE in outcomes. Video https://www.dropbox.com/s/7byc8nsqupgetsp/2020%20ISDE%20movie%20for%20submission.wmv?dl=0.

scholarly journals Impact of nasogastric decompression on gastric tube size after McKeown minimally invasive esophagectomy: A retrospective controlled cohort study

2021 ◽  
Author(s):  
Duo Jiang ◽  
Xian-Ben Liu ◽  
Wen-Qun Xing ◽  
Pei-Nan Chen ◽  
Shao-Kang Feng ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Gastric Tube ◽  
Enhanced Recovery ◽  
Minimally Invasive Esophagectomy ◽  
Tube Size ◽  
Invasive Esophagectomy ◽  
Chest X Ray ◽  
The Right ◽  
The Impact ◽  
Nasogastric Decompression

Abstract Purpose: This retrospective study evaluated the impact of nasogastric decompression (NGD) on gastric tube size to optimize the Enhanced Recovery After Surgery protocol after McKeown minimally invasive esophagectomy (MIE). Methods: Overall, 640 patients were divided into two groups according to nasogastric tube (NGT) placement intraoperatively. Using propensity score matching, 203 pairs of individuals were identified for gastric tube size comparisons on postoperative days (PODs) 1 and 5. Results: Gastric tubes were larger in the non-NGD group than the NGD group on POD 1 (vertical distance from the right edge of the gastric tube to the right edge of the thoracic vertebra, 22.2 [0–34.7] vs. 0 [0–22.5] mm, p <0.001). No difference was noted between the groups on POD 5 (18.5 [0–31.7] vs. 18.0 [0–25.4] mm, p =0.070). Univariate and multivariate analyses showed that non-NGD was an independent risk factor for gastric tube distention on POD 1. No difference in the incidence of complications (Clavien–Dindo（CD）≥2) (40 (23.0%) vs. 46 (19,8%), p =0.440), pneumonia (CD≥2) (29 [16.8%] vs. 30 [12.9%], p =0.280) or anastomotic leakage (CD≥3) (3 [1.7%] vs. 6 [2.6%], p =0.738) were noted between the without gastric tube distention group and with gastric tube distention group. Conclusion: Intraoperative NGT placement reduces gastric tube distention rates after McKeown MIE on POD 1, but the complications are similar to those of unconventional NGT placement. This finding is based on NGT placement or replacement at the appropriate time postoperatively through bedside chest X-ray examination.

Single port Thoracoscopic Minimally Invasive Esophagectomy for esophageal cancer: Report of 2 cases.

2020 ◽  
Vol 46 (2) ◽  
pp. e136-e137
Author(s):  
Emir Çapkınoğlu ◽  
Uygar Demir ◽  
Tunç Laçin ◽  
Mehmet Mihmanlı
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Single Port ◽  
Minimally Invasive Esophagectomy ◽  
Invasive Esophagectomy

PS01.219: SINGLE-PORT THORACOSCOPIC MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 112-112
Author(s):  
Yong Yuan
Keyword(s):  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Single Port ◽  
Minimally Invasive Esophagectomy ◽  
Operation Time ◽  
Surgical Instruments ◽  
Thoracoscopic Esophagectomy ◽  
Invasive Technique ◽  
Invasive Approach ◽  
Invasive Esophagectomy

Abstract Background This study was conducted to optimize the surgical procedures for single-port thoracoscopic esophagectomy, and to explore its potential advantages over multi-port minimally invasive esophagectomy. Methods For single-port thoracoscopic esophagectomy, the patient was placed in left lateral-prone position and a 4-cm incision through the 4th-5th intercostal space was taken on the postaxillary line. The 10-mm camera and two or three surgical instruments were used for the VATS esophagectomy and radical mediastinal lymph node dissection. The camera position was different for the upper and lower mediastinal regions. Mobilization of stomach was conducted via multiple-port laparoscopic approach. Cervical end-to-side anastomosis was completed by hand-sewn procedures.A propensity-matched comparison was made between the single-port and four-port thoracoscopic esophagectomy groups. Results From 2014 to 2016, 56 matched patients were analyzed. There was no conversion to open surgery or operative mortality. The use of single-port thoracoscopic esophagectomy increased the length of operation time in comparison with using multiple-port minimally invasive technique (mean, 257 vs. 216 min, P = 0.026). The time taken for thoracic procedure in the single-port group was significant longer that in the multi-port group (mean, 126 vs. 84 min, P < 0.001). There were no significant differences between groups in the number of lymph nodes dissected, blood loss, complications or hospital stay (P > 0.05). In single-port thoracoscopic group, the pain in the abdomen was more severe than that in the chest (P = 0.042). The pain scores for postoperative day 1 and day 7 were significantly lower in the single-port group as compared with multiple-port group (P = 0.038 and P < 0.001), a similar trend could be seen for the pain score on postoperative day 3 (P = 0.058). Conclusion Single-port thoracoscopic esophagectomy contributes to reducing postoperative pain with an acceptable increase of operation time, which does not compromise surgical radicality and has similar short-term postoperative outcomes when compared with multiple-port minimally invasive approach. Disclosure All authors have declared no conflicts of interest.

scholarly journals Repair of tracheoesophageal fistula with pedicled sternocleidomastoid muscle flap after minimally invasive esophagectomy: A case report

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Yixing Li ◽  
◽  
Kun Fan ◽  
Jizhao Wang ◽  
Hongyi Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Tracheoesophageal Fistula ◽  
Rare Complication ◽  
Minimally Invasive Esophagectomy ◽  
Clinical Manifestations ◽  
Muscle Flap ◽  
Sternocleidomastoid Muscle ◽  
Invasive Esophagectomy ◽  
Surgical Methods ◽  
Sternocleidomastoid Muscle Flap

Background: Tracheoesophageal Fistula (TEF) is a rare complication after Minimally Invasive Esophagectomy (MIE). Various surgical methods are available for repairing TEF. In this report, we have shown the importance and feasibility of pedicled Sternocleidomastoid Muscle (SCMM) flap in dealing with TEF. Methods and results: A 57-year-old woman with esophageal squamous cell carcinoma underwent MIE in our hospital. TEF was diagnosed based on some clinical manifestations, like coughing after swallowing, a month after MIE. During the repair operation, we have utilized pedicled SCMM flap to cover the fistula after suturing the esophagus and trachea separately. No major complications occurred after the operation, and the prognosis was good. Conclusions: Pedicled sternocleidomastoid muscle flap was convenient, reliable and efficient in covering the fistula, therefore, we recommend it as the routine surgical method. However, randomized controlled trials are further needed to confirm this recommendation. TEF can be reconstructed with a pedicled SCMM flap. This method can effectively avoid further complications. Keywords: minimally invasive esophagectomy; esophageal cancer; tracheoesophageal fistula; sternocleidomastoid muscle.

Outcomes associated with minimally invasive esophagectomy techniques.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 171-171
Author(s):  
Andrea M. Abbott ◽  
Matthew Doepker ◽  
Ravi Shridhar ◽  
Sarah E. Hoffe ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Surgical Techniques ◽  
Esophageal Resection ◽  
Oncologic Outcomes ◽  
Surgical Approaches ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Operative Outcomes ◽  
Estimated Blood Loss

171 Background: Surgery is pivotal in the management of patients with esophageal cancer. Recent prospective data demonstrates advantages of minimally invasive techniques. However, varying surgical techniques precludes the recommendation of a standard approach. We sought to examine our outcomes with differing approaches to minimally invasive esophagectomy. Methods: We queried a prospective esophageal database to identify patients who underwent minimally invasive esophagectomy (MIE) from 1994 and 2014. Surgical approaches included trans-hiatal (TH), Ivor Lewis (IVL), and robotic assisted Ivor Lewis (RAIL). Demographics, operative variables and post-operative complications were all compared. Results: We identified 280 patients who underwent MIE with a mean age of 65.65 ± 10.5 and a median follow-up of 48 months. Fifty-seven patients underwent IVL, 78 underwent TH, and 145 underwent RAIL. The length of operation was significantly longer in IVL and RAIL approaches compared to TH (TH=242, IVL=320, RAIL=415, p=0.001). Estimated blood loss did not differ between cohorts (TH=150, IVL=125, RAIL=158, p=0.8). Anastomotic leakage, stricture, pneumonia, and wound infections were all higher in the TH compared to the trans-thoracic approaches p=0.04, p=0.02, p=0.01, and p<0.001 respectively. Operative mortality was low for each cohort and did not differ between approaches (TH=2.6%, IVL=0%, RAIL=2%, p=0.2). The median length of hospitalization also did not differ between groups (TH=10 days, IVL=8.5 days, and RAIL=9 days, p=0.15). Adequacy of oncologic resection was measured by margins and nodal harvest. There was decreased R1 resections in both the IVL and RAIL compared to TH (TH=8%, IVL=0%, and RAIL=0% p=0.04). Additionally, the mean number of lymph nodes harvested was lower in patients undergoing TH compared to IVL and RAIL groups (TH=9.2, IVL=12.8, and RAIL=20.6, p=0.05). Conclusions: In our large series comparing minimally invasive approaches to esophageal resection we have demonstrated improved operative outcomes and oncologic outcomes in trans-thoracic approaches compared to trans-hiatal approaches. We recommend that patients undergoing minimally invasive esophagectomy be strongly considered for a trans-thoracic approach.

351 SINGLE-PORT MINIMALLY INVASIVE ESOPHAGECTOMY TO TREAT ESOPHAGEAL CANCER: EXPERIENCE OF 144 CASES

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Jang-Ming Lee ◽  
Chen Ke-Cheng ◽  
Lin Mong-Wei ◽  
Yang Pei-Wen ◽  
Huang Pei-Ming
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Single Incision ◽  
Single Port ◽  
Minimally Invasive Esophagectomy ◽  
Pulmonary Complications ◽  
Term Survival ◽  
Invasive Esophagectomy ◽  
Laparoscopic Procedures ◽  
The Mean

Abstract   Single-incision thoracoscopic and laparoscopic procedures has have been applied in treating various diseases. However, it is limited in literature for such procedures used in treating esophageal cancer. Methods Minimally invasive esophagectomy (MIE) with a single-incision approach in the thoracoscopic and laparoscopic procedures was attempted in 144 patients with esophageal cancer. Results There was 96 patients underwent a McKeown procedure and 48 an Ivor Lewis procedure repectively. The mean ventilator usage of the patients after surgery was 0.3 ± 0.6 days, the mean ICU stay was 7.42 ± 17.15 days, and the mean number of dissected lymph nodes was 43.5 ± 21.8. There 11 patients suffered from postoperative complications, including 3 pulmonary complications, 4 anastomotic leakage and 4 vocal cord palsy. There are no 30-day mortality, however, there were one patient died from ARDS 40 days after surgery. Conclusion Single-port MIE seems to be a feasible option for treating patients with esophageal cancer, which offers an acceptable perioperative surgical outcome. However, the long-term survival results of the patients requires to be follow-up in the future.

Single-port laparoscopic and thoracoscopic Ivor-Lewis minimally invasive esophagectomy

ASVIDE ◽  
2018 ◽  
Vol 5 ◽  
pp. 899-899
Author(s):  
Jen-Hao Chuang ◽  
Shun-Mao Yang ◽  
Pei-Wen Yang ◽  
Pei-Ming Huang ◽  
Jang-Ming Lee
Keyword(s):  
Minimally Invasive ◽  
Single Port ◽  
Minimally Invasive Esophagectomy ◽  
Ivor Lewis ◽  
Invasive Esophagectomy
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