687 ADVERSE EVENTS DURING MINIMALLY INVASIVE ESOPHAGECTOMY IN PRONE POSITION

Abstract Since the initial description of laparoscopic fundoplication in 1991 for the treatment of gastroesophageal reflux disease, different minimally invasive procedures have been developed until nowadays, when esophagectomy is performed using combined thoracoscopy and laparoscopy. Objective: The aim of our study is to analyze the intraoperative complications of minimally invasive esophagectomy in prone position. Methods Between November 2011 and January 2021, 70 patients underwent minimally invasive esophagectomy in prone position in the Hospital Interzonal General de Agudos General San Martín and private practice of La Plata city. Results During the abdominal stage one patient presented coronary vessel injury and the other with short vessel injury. The complications occurring in the thoracic stage included lung injury, azygos arch injury, thoracic duct section, laryngeal recurrent nerve lesion, main stem bronchus injury, and pericardium lesion, during lymph node resection. Most of these complications occurred in the first 30 patients, while in the remaining 40 cases only two complications (p value = 0.4). Conclusion Minimally invasive esophagectomy in prone position is a feasible and safe procedure that can cause serious intraoperative complications due to its complexity. Although the results of our series did not show statistically significant differences, the number of complications during surgeries performed by the same team showed an important reduction associated with better training.

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Eventos adversos durante la esofagectomía mininvasiva en posición prona y su relación con la curva de aprendizaje

Revista Argentina de Cirugía ◽

10.25132/raac.v111.n2.1363.es ◽

2019 ◽

Vol 111 (2) ◽

pp. 71-78

Author(s):

Daniel N. Velasco Hernández ◽

◽

Héctor R. Horiuchi ◽

Lucas A. Rivaletto ◽

Carolina Gómez Oro ◽

...

Keyword(s):

Lung Injury ◽

Adverse Events ◽

Minimally Invasive ◽

Prone Position ◽

Minimally Invasive Esophagectomy ◽

Intraoperative Complications ◽

Nerve Lesion ◽

Recurrent Nerve ◽

Safe Procedure ◽

Invasive Esophagectomy

Background: Since the initial description of laparoscopic fundoplication in 1991 for the treatment of gastroesophageal reflux disease, different minimally invasive procedures have been developed until nowadays, when esophagectomy is performed using combined thoracoscopy and laparoscopy. Objective: The aim of our study is to analyze the adverse events of minimally invasive esophagectomy in prone position during the learning curve. Material and methods: Between November 2011 and June 2017, 36 patients underwent minimally invasive esophagectomy in prone position in the Hospital Interzonal General de Agudos (HIGA) San Martín and the Instituto de Diagnóstico de La Plata. Results: During the abdominal stage one patient presented coronary vessel injury. The complications occurring in the thoracic stage included lung injury (n =2), azygos arch injury (n = 1), thoracic duct dissection (n = 1), laryngeal recurrent nerve lesion (n = 1) and main stem bronchus injury (n = 1) during lymph node resection. Most of these complications occurred in the first 20 patients, while in the remaining 16 cases only lung injury occurred (p = 0.10) Conclusion: Minimally invasive esophagectomy in prone position is a feasible and safe procedure that can cause serious intraoperative complications due to its complexity. Although the results of our series did not show statistically significant differences, the number of adverse events during surgeries performed by the same team showed an important reduction associated with better training.

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Linfadenectomía mediastinal para el cáncer de esófago mediante un abordaje miniinvasivo. Diferencias entre en el adenocarcinoma y el carcinoma escamoso

Acta gastroenterológica latinoamericana ◽

10.52787/usqz9578 ◽

2020 ◽

Vol 50 (2) ◽

Author(s):

Norberto Daniel Velasco Hernández ◽

Héctor Raúl Horiuchi ◽

Lucas Alberto Rivaletto ◽

María Micaela Zicavo ◽

Lucila Fernández

Keyword(s):

Minimally Invasive ◽

Prone Position ◽

Oesophageal Cancer ◽

Minimally Invasive Esophagectomy ◽

Intraoperative Complications ◽

Recurrent Nerve ◽

Invasive Approach ◽

Mediastinal Lymphadenectomy ◽

Invasive Esophagectomy ◽

Squamous Cells

Background. In the multimodal treatment era, surgery remains the mainstay for oesophageal cancer. The type of lymphadenectomy raises important controversies between eastern and western countries, mainly due to the lack of consensus on its extension. Objectives. Analyse the type of mediastinal lymphadenectomy performed for adenocarcinoma and squamous cells carcinoma, of a group of patients who underwent a prone position minimally invasive esophagectomy. Material and methods. From November 2011 to August 2019, 51 patients were treated for potentially curable oesophageal cancer who underwent minimally invasive esophagectomy with two-field lymphadenectomy (mediastinal and abdominal). Based on the histological type and location of the tumour, the different types of lymph nodes dissection were performed. Results. The median of nodes obtained for Adenocarcinoma was 5.0 (3-16) while for squamous cells carcinoma cases it was 8.0 (4-38) (p = 0.019). Two intraoperative complications were recorded: a lesion of the left source bronchus during sub carinal lymphadenectomy, and injury to the right recurrent nerve during an extended lymphadenectomy. Conclusion. We can conclude the mediastinal lymphadenectomy is a feasible procedure to perform with a minimally invasive approach in prone position, for offering an adequate visualization of the anatomical structures and obtaining an acceptable number of nodes. However, it is subject to complications, some of which could be serious.

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Intrathoracic Esophagogastric Anastomosis Using a Linear Stapler Following Minimally Invasive Esophagectomy in the Prone Position

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-012-2009-0 ◽

2012 ◽

Vol 17 (2) ◽

pp. 397-402 ◽

Cited By ~ 13

Author(s):

Hiroshi Okabe ◽

Eiji Tanaka ◽

Shigeru Tsunoda ◽

Kazutaka Obama ◽

Yoshiharu Sakai

Keyword(s):

Minimally Invasive ◽

Prone Position ◽

Minimally Invasive Esophagectomy ◽

Esophagogastric Anastomosis ◽

Linear Stapler ◽

Invasive Esophagectomy

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Minimally invasive esophagectomy: Preservation of arch of Azygos vein in prone position

Journal of Minimal Access Surgery ◽

10.4103/jmas.jmas_267_20 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0

Author(s):

Madhabananda Kar ◽

Mohammed Imaduddin ◽

DillipK Muduly ◽

Mahesh Sultania ◽

Tim Houghton ◽

...

Keyword(s):

Minimally Invasive ◽

Prone Position ◽

Minimally Invasive Esophagectomy ◽

Azygos Vein ◽

Invasive Esophagectomy

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PS02.250: PREEMPTIVE ENDOSCOPIC VACUUM DRAINAGE TO PREVENT ANASTOMOTIC LEAKAGE IN UPPER-GI SURGERY: A GAME-CHANGING TECHNOLOGY?

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.250 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 194-194

Author(s):

Henner M Schmidt ◽

Diana Vetter ◽

Christoph Gubler ◽

Piero Valli ◽

Bernhard Morell ◽

...

Keyword(s):

Minimally Invasive ◽

Conflicts Of Interest ◽

Minimally Invasive Esophagectomy ◽

Case Series ◽

Gastric Surgery ◽

Safe Procedure ◽

Comprehensive Complication Index ◽

Invasive Esophagectomy ◽

Upper Gi ◽

Primary Endpoints

Abstract Background Anastomotic leak (AL) remains a major cause of morbidity in upper-GI surgery. In many centers, endoluminal vacuum drainage (EVD) has become the mainstay of therapy for AL after esophageal and gastric resections. A new idea is to use the EVD technology in a preemptive setting. In this context, we present a case series of patients that received PEVD upon completion of the anastomosis during esophago-gastric surgery. Methods Intraoperative PEVD was performed in 10 consecutive patients undergoing minimally invasive esophagectomy with cervical (n = 1) or high intrathoracic (n = 6) anastomosis, and open transhiatally extended (n = 1) or minimally invasive (n = 2) total gastrectomy. The EVD device was removed after three to six (mean 4) days, and the anastomosis was endoscopically inspected for ischemia and AL. Additional contrast radiography, computed tomography, or gastroscopy to exclude AL was performed in seven patients. Primary endpoints in this retrospective series was AL; secondary endpoints were the postoperative morbidity measured by the Clavien-Dindo (CD) classification and the comprehensive complication index (CCI), all at 30 days after surgery. Results Perioperative mortality was 0% with uneventful anastomotic healing in all patients of this series (AL rate 0%, anastomotic stenosis 0%). There were no adverse events attributable to PEVD. None of the patients experienced major morbidity (> CD grade IIIa) during the postoperative course. The median postoperative ICU and hospital stay was 1 (IQR 1-1.75) and 14 (IQR 12-16) days, respectively. Five patients (50%) developed at least one complication, mostly related to infection (2 patients) and pulmonary events (2 patients). The mean CCI at 30 days after surgery was 13.7 (range 0-39.5). Conclusion PEVD appears to be a safe procedure that may emerge as a groundbreaking technology in patients undergoing esophageal or gastric resection. Further research is needed to elucidate the true potential of this technique. Disclosure All authors have declared no conflicts of interest.

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PS01.138: EXPERIENCE FROM 102 PATIENTS WITH CONTINUOUS INTRAOPERATIVE VAGUS NERVE STIMULATION DURING MINIMALLY INVASIVE ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.138 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 89-89

Author(s):

Ian Yu Hong Wong ◽

Raymond King Yin Tsang ◽

Desmond Kwan Kit Chan ◽

Claudia Lai Yin Wong ◽

Tsz Ting Law ◽

...

Keyword(s):

Minimally Invasive ◽

Vocal Cord ◽

Nerve Stimulation ◽

Vocal Cord Paralysis ◽

Minimally Invasive Esophagectomy ◽

Intraoperative Complications ◽

Early Recovery ◽

Invasive Esophagectomy ◽

Assessment And Treatment

Abstract Background The incidence of recurrent laryngeal nerve (RLN) injury after esophagectomy can be as high as 60–70% especially when lymphadenectomy is performed along bilateral RLN. Vocal cord paralysis is associated with increased pulmonary complication rate, longer hospital stay, and impaired quality-of-life. The authors have modified the Continuous Intraoperative Nerve Monitoring (CIONM) method for minimally invasive esophagectomy. This study reviews our experience in the first 102 patients. Methods From May 2014 to January 2018, patients who underwent thoracoscopic esophagectomy were recruited. CIONM and intermittent nerve stimulation were routinely used during left RLN lymphadenectomy. For right RLN dissection, only intermittent nerve stimulation was used because of much lower chance of nerve injury. Routine direct laryngoscopy was performed on postoperative day one to assess the vocal cord status. Patients with RLN palsy are referred to otorhinolaryngologist for assessment and treatment. Surgical outcome, especially RLN palsy and recovery rates were documented. Results 102 patients were recruited and 73 patients had more than one year follow up. Twenty-two patients had RLN palsy (21.6%); right side in 3, left side in 18, and bilateral in one. Thirty-eight patients (37%) had only unilateral or no RLN dissection performed. This was because of R2 resection negating the benefits of RLN dissection (15.6%), poor pulmonary exposure (9.8%), other technical difficulties (7.8%), preoperative vocal cord palsy (2%), intraoperative complications (1%) and uncertain contralateral nerve integrity (1%). For those 90 patients with successful CIONM, 20 RLN palsy (22.2%), 10 of whom underwent injection thyroplasty within 2–80 days. Thyroplasty was not performed in 12 patients as they had good compensation from the contralateral cord (58.3%), early recovery within 2 weeks (16.7%) tracheostomized status (16.7%) or refusal (8.3%). Thirteen patients (59%) recovered within 2–72 weeks (Median 6 weeks). For the 73 patients with more than 1 year follow up, only 4 has residual vocal cord paralysis, making a genuine cord palsy rate of 5.5%. Conclusion Lymphadenectomy along bilateral RLN is technically demanding. CIONM is a sensitive tool to guide surgeons for safer dissection. Proper patient selection, postoperative assessment and treatment protocol can reduce the morbidity of RLN injury. Majority of the vocal cord paralysis is temporary Disclosure All authors have declared no conflicts of interest.

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Thoracic duct identification with indocyanine green fluorescence during minimally invasive esophagectomy with patient in prone position

Diseases of the Esophagus ◽

10.1093/dote/doaa030 ◽

2020 ◽

Vol 33 (12) ◽

Cited By ~ 2

Author(s):

Massimo Vecchiato ◽

Antonio Martino ◽

Massimo Sponza ◽

Alessandro Uzzau ◽

Antonio Ziccarelli ◽

...

Keyword(s):

Minimally Invasive ◽

Indocyanine Green ◽

Prone Position ◽

Thoracic Duct ◽

Minimally Invasive Esophagectomy ◽

Standard Procedure ◽

Transthoracic Esophagectomy ◽

Green Fluorescence ◽

Indocyanine Green Fluorescence ◽

Invasive Esophagectomy

Abstract Chylothorax is a serious complication of transthoracic esophagectomy. Intraoperative thoracic duct (TD) identification represents a possible tool for preventing or repairing its lesions, and it is most of the time difficult, even during high-definition thoracoscopy. The aim of the study is to demonstrate the feasibility of using near-infrared fluorescence-guided thoracoscopy to identify TD anatomy and check its intraoperative lesions during minimally invasive esophagectomy. A 0.5 mg/kg solution of indocyanine green (ICG) was injected percutaneously in the inguinal nodes of 19 patients undergoing minimally invasive esophagectomy in a prone position, before thoracoscopy. TD anatomy and potential intraoperative lesions were checked with the KARL STORZ OPAL1® Technology. In all of the 19 patients where transthoracic esophagectomy was feasible, the TD was clearly identified after a mean of 52.7 minutes from injection time. The TD was cut for oncological radicality in two patients, and it was successfully ligated under the ICG guide. No postoperative chylothorax or adverse reactions from the ICG injection occurred. The TD identification with indocyanine green fluorescence during minimally invasive esophagectomy is a simple, effective, and non-time-demanding tool; it may become a standard procedure to prevent postoperative chylothorax.

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PS01.159: THE IMPROVED POSTOPERATIVE RECOVERY OUTCOMES FROM MINIMALLY INVASIVE ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.159 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 94-94

Author(s):

Xiaobin Zhang ◽

Zhigang Li

Keyword(s):

Minimally Invasive ◽

Anastomotic Leakage ◽

Conflicts Of Interest ◽

Perioperative Complications ◽

Minimally Invasive Esophagectomy ◽

Postoperative Recovery ◽

Open Group ◽

Recurrent Nerve ◽

Invasive Esophagectomy ◽

Open Esophagectomy

Abstract Background The minimally invasive esophagectomy (MIE) has been developed in the past three decades. In our institution, the MIE was first introduced in 2012, and the proportion of MIE was used for over 70% in 2016–2017. This study aimed to compare the postoperative recovery outcomes between MIE and open esophagectomy in different period. Methods A total of 725 patients were enrolled in this study including 248 patients who underwent open esophagectomy within 2012–2013 and 477 patients who underwent MIE within 2016–2017. All patients received McKeown esophagectomy with two-field lymphadenectomy. And the perioperative complications were recorded according to the Esophagectomy Complications Consensus Group (ECCG) complication definitions. Results There was no statistically difference between OPEN and MIE groups with regard to preoperative characters except for age (60.8 ± 7.2 vs. 62.7 ± 7.7, P < 0.001) and body mass index (22.4 ± 3.0 vs. 23.1 ± 3.0, P = 0.002). One (0.2%) patient in the MIE group died within 90 days from anastomotic leakage, compared to 6 (2.4%) patients in the OPEN group (P = 0.004). The length of hospital stay was shorter in the MIE group (11 range 6–131 days, vs. 15 range 9–164 days, P < 0.001). The MIE group was in favor of lower complications (32.3% vs. 46.4%, P < 0.001). Pneumonia was the most common complications in both groups (12.6% in MIE vs. 27.4% in OPEN, P < 0.001). 15 (3.1%) patients in the MIE group experienced atrial arrhythmias compared with 30 (12.1%) in the OPEN group (P < 0.001). Lower anastomotic leakage was noted in the MIE group (11.5% vs. 25.4%, P < 0.001), as well as the wound infection (0.2% vs. 2.8%, P = 0.001), than in the OPEN group. The recurrent nerve injury was higher in the MIE group (11.7% vs. 6.5%, P = 0.024) but with more lymph nodes dissection along the recurrent laryngeal nerve (3.8 ± 2.8 vs. 1.4 ± 2.0, P < 0.001). Conclusion The MIE was associated with better postoperative recovery outcomes and lower mortality. MIE technique should be considered as the mainstay surgical treatment for esophageal cancer in the current and future period. Disclosure All authors have declared no conflicts of interest.

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