VS03.05: VASCULAR ASSESSMENT OF THE GASTRIC TUBE IN MINIMALLY INVASIVE IVOR-LEWIS ESOPHAGECTOMY USING INDOCYANINE GREEN

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 48-48
Author(s):  
Dulce Nombre De Maria Momblan ◽  
Victor Turrado-Rodriguez ◽  
Alba Torroella ◽  
Ainitze Ibarzabal ◽  
Arlena Sofia Espinoza ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Conflicts Of Interest ◽  
Vascular Supply ◽  
Gastric Conduit ◽  
Leak Rate ◽  
Esophagogastric Anastomosis ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Ivor Lewis Esophagectomy

Abstract Description One of the major concerns in esophagic surgery is the safety of the esophagogastric anastomosis. Anastomotic leak is associated with important morbidity and mortality. Leak rates have been reported in 4.7% of patients in the Ivor-Lewis procedure and 5.2% for cervical anastomosis. Leak rate has been associated with insufficient vascular supply to the gastric conduit. Indocyanine green (ICG) assessment of the vascularization may be a useful tool to avoid this dreadful complication. Methods A 50-year-old man with medical history of high blood pressure and right pneumothorax was diagnosed of adenocarcinoma of the lower esophagus cT3N3. Neoadjuvant chemo-radiotherapy following CROSS principles was administered. Six weeks after the end of neoadjuvant chemo-radiotherapy a minimally invasive Ivor-Lewis esophagectomy was performed. ICG helped the identification of the right gastroepiploic arcade and of the adequate vascular supply to the gastric conduit. During thoracoscopy, ICG was helpful to assess the vascular supply to the gastric conduit after pull-up into the chest and to check the vascularization of the esophagogastric anastomosis. Results Postoperative evolution was uneventful. Oral intake was resumed on the third postoperative day. Patient was discharged on the 8th postoperative day. Conclusions ICG assessment of the vascularization of the gastric conduit is feasible, safe and helpful in Ivor-Lewis minimally invasive esophagectomy and may decrease the leak rate. Disclosure All authors have declared no conflicts of interest.

Indocyanine green perfusion assessment of the gastric conduit in minimally invasive Ivor Lewis esophagectomy

2021 ◽  
Author(s):  
Keouna Pather ◽  
Adeline M. Deladisma ◽  
Christina Guerrier ◽  
Isaac R. Kriley ◽  
Ziad T. Awad
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Gastric Conduit ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Perfusion Assessment

PS01.204: ANASTOMOTIC LEAKS AFTER IVOR-LEWIS ESOPHAGECTOMY: INDOCYANINE GREEN NEAR-INFRERED ANGIOGRAPHY FOR GASTRIC CONDUIT BLOOD SUPPLY EVALUATION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 107-107
Author(s):  
Paolo Parise ◽  
Andrea Cossu ◽  
Leonardo Garutti ◽  
Francesco Puccetti ◽  
Ugo Elmore ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Blood Supply ◽  
Near Infrared ◽  
Conflicts Of Interest ◽  
Gastric Conduit ◽  
Smoking History ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Group A ◽  
Group B

Abstract Background Indocyanine Green—Angiography (ICG-A) has been recently introduced for visceral perfusion evaluation. Aim of this study is to assess whether the intraoperative use of ICG-A can improve the evaluation of blood supply of the gastric conduit in Ivor-Lewis esophagectomy for cancer. Methods This is an interim analysis of a prospective interventional study ongoing at our Institution, on 160 Ivor-Lewis esophagectomy patients. After an intravenous bolus of ICG during the abdominal and thoracic stage, the gastric conduit perfusion was evaluated by means of a near infrared ICG-A and graded as ‘well’, ‘hypo-perfused’ or ‘ischemic’. If present, the ischemic or hypo-perfused area was resected. Demographic and clinical parameters and others, such as conduit perfusion speed, intra or post-operative hypotensive episodes have been analyzed. Results Currently 26 patients have been enrolled. An anastomotic leak of any grade was identified in 7 patients. Patients were divided in Group A (7 patients) who developed a leak and Group B (19 patients) who do not. No statistically significant differences were evidenced on demographic and preoperative clinical features, except for higher cigarette smoking history incidence in Group A. Those who developed a leak had an ‘hypo-perfused’ conduit at ICG-A in 71.4% and those who do not in only 15.8% (p 0.014). Median time from ICG injection to appearance of fluorescence at the basis of the gastric conduit was significantly longer in Group A than in Group B, 36 sec. (32–43.5) vs 28 sec. (20–39.8) (p 0.04) but median gastric conduit perfusion speed was similar. Patients in Group B had a higher median width of the conduit than Group A, 5cm (5.0–6.0) vs 4 (4.0–5.0) (p 0.032). Post-operative prolonged hypotensive episodes were seen more frequently in Group A than Group B (p 0.028). No differences were evidenced in terms of fluids infusions, blood loss, conduit length or intraoperative hypotensive episodes. Conclusion Preliminary results seem to show the usefulness of ICG-A in identifying patients at risk of leakage. Nevertheless no reduction of leakage incidence was induced by surgical strategy modification, probably because post-operative events may affect clinical course too. Definitive data have to be awaited. Disclosure All authors have declared no conflicts of interest.

VS03.04: MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY WITH ROBOTIC ASSISTANCE AND IMMUNOFLUORESCENCE: MODULAR STEP UP APPROACH FOR SAFE INTRODUCTION OF NEW TECHNOLOGY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 48-48
Author(s):  
Hans Fuchs ◽  
Rolf Lambertz ◽  
Wolfgang Schröder ◽  
Jessica Leers ◽  
Christiane Bruns
Keyword(s):  
Minimally Invasive ◽  
New Technologies ◽  
Conflicts Of Interest ◽  
New Technology ◽  
Gastrointestinal Surgery ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Center Of Excellence ◽  
Academic Center ◽  
Upper Gastrointestinal

Abstract Description Minimally invasive technologies have improved outcomes after esophagectomy and the use of robotic technology in Europe is rapidly increasing. Aim of this study is to evaluate the introduction of new technologies in a center of excellence for upper gastrointestinal surgery. Methods A standardized teaching protocol of a complete OR team was performed in simulation and animal models at the center for the future of surgery (San Diego, CA) and IRCAD (Strasbourg, France) to receive certification as console surgeons. Starting 02/2017 the davinci xi and stryker ICG laparoscopy systems were introduced at our academic center (certified center of excellence for surgery of the upper gastrointestinal tract, n > 300 esophageal cases/year). After simple training procedures based on our minimally invasive expertise were performed, difficulty was increased based on a modular step up approach to safely perform robotic thoracic assisted Ivor Lewis esophagectomy. Results From 02/2017–02/2018, a total of 35 robotic cases were performed. All cases were performed safely without operation-associated complications. Level of difficulty was increased based on our modular step up approach without quality compromises. Video documentation using the new technology is provided. Conclusion The standardized training protocol and our modular step up approach allowed safe introduction of the new technology used. All cases were performed safely without operation-associated complications. Disclosure All authors have declared no conflicts of interest.

scholarly journals Thoracoscopic management of volvulus of the gastric conduit following minimally invasive Ivor-Lewis esophagectomy

2015 ◽  
Vol 30 (7) ◽  
pp. 3098-3098
Author(s):  
Jeremy Linson ◽  
Michael Latzko ◽  
Bestoun Ahmed ◽  
Ziad Awad
Keyword(s):  
Minimally Invasive ◽  
Gastric Conduit ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

PS02.012: AN IMPORTANT COMPLICATION OF MINIMALLY INVASIVE ESOPHAGECTOMIES: HIATAL HERNIA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 123-123
Author(s):  
Atila Eroglu ◽  
Yener Aydin ◽  
Ali Ulas ◽  
Coskun Daharli
Keyword(s):  
Minimally Invasive ◽  
Hospital Stay ◽  
Hiatal Hernia ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Length Of Hospital Stay ◽  
Esophageal Resection ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
The Mean

Abstract Background Development of hiatal hernia after esophageal resection is a known complication. However, due to the spread of minimally invasive esophagectomy, complications of hiatal hernia seems to increase. This study aimed to present our cases with hiatal hernia after Ivor Lewis minimally invasive esophagectomy. Methods After Ivor Lewis minimally invasive esophagectomy, five cases of hiatal hernia were observed. Patients' age, sex, symptoms, diagnosis, herniated organs, surgical method, morbidity and mortality rates and hospital stay were reviewed. Results Three of the patients were male and two were female. The mean age of the patients was 56.2 years (35–71 years). Hiatal hernia was detected after an average of 1.4 years with minimal invasive esophagectomies (5 months, 1 year, 1 year, 18 months and 3 years respectively). Three of the cases were symptomatic and two cases were asymptomatic. Thorax CT was used in all cases, and two cases were additionally imaged with barium esophagography. Herniated organs were: omentum in 5 cases, transverse colon in 4 cases, small bowel in two cases. All cases were laparoscopically approached. Diaphragmatic defects were repaired using nonabsorbable sutures in all cases. No complication and mortality was observed in patients. The mean length of hospital stay was 4.9 days (range, 3 to 10 days). Conclusion Hiatal hernia is more frequently seen in minimally invasive esophagectomies than open esophagectomies. Patients undergoing minimal esophagectomy should be closely monitored for hiatal hernia postoperatively. These cases can also be treated by minimally invasive laparoscopy. Disclosure All authors have declared no conflicts of interest.

RA01.03: HAND-SEWN INTRATHORACIC ESOPHAGO-GASTRIC ANASTOMOSIS IN 2-STAGE TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 18-18
Author(s):  
Alexandros Charalabopoulos ◽  
Justin Lawrence ◽  
Ali Kordzadeh ◽  
Bruno Lorenzi
Keyword(s):  
Minimally Invasive ◽  
Suture Material ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Leak Rate ◽  
Invasive Esophagectomy ◽  
Esophagectomy For Cancer ◽  
Gastric Anastomosis

Abstract Description This is a video of a hand-sewn 2-layer end-to-side intra-thoracic esophago-gastric anastomosis performed thoracoscopically during a totally minimally invasive 2-stage esophagectomy for cancer. The suture material used is the barbed V-Lock. We routine perform this anastomosis in all 2-stage minimally invasive esophagectomies in our Unit since 2016. We have performed about 50 consecutive esophagectomies with this anastomosis with < 3% leak rate. Disclosure All authors have declared no conflicts of interest.

RA01.08: LAPAROSCOPIC ROUX-EN-Y GASTROJEJUNOSTOMY FOR GASTRIC CONDUIT OUTLET OBSTRUCTION FOLLOWING ESOPHAGECTOMY FOR CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 19-19
Author(s):  
Daniele Bernardi ◽  
Matteo Porta ◽  
Emanuele Asti ◽  
Veronica Lazzari ◽  
Chiara Ceriani ◽  
...  
Keyword(s):  
Gastric Outlet Obstruction ◽  
Conflicts Of Interest ◽  
Outlet Obstruction ◽  
Gastric Conduit ◽  
Long Term Results ◽  
Ivor Lewis ◽  
Gastric Emptying Scintigraphy ◽  
Ivor Lewis Esophagectomy ◽  
Swallow Study

Abstract Description After Ivor Lewis esophagectomy, gastric outlet obstruction refractory to prokinetic therapy and/or endoscopic pyloric dilatation is a challenging clinical problem. Thoracoscopic implant of a gastric neurostimulator has been reported to be effective, but long-term results are lacking. The patient, a 57-year-old woman, underwent a Ivor Lewis esophagectomy for T1N0 adenocarcinoma in 2007. Postoperatively, the patient complained of persistent dysphagia, regurgitation, and 29-kg weight loss. A mechanical obstruction was ruled out by barium swallow study and upper gastrointestinal endoscopy. Several conservative attempts with prokinetic agents and endoscopic dilatations failed, and the patient was exclusively fed through jejunostomy until the thoracoscopic implant of a gastric neurostimulator in October 2015. The postoperative course was uneventful. At six-months follow-up, the patient was able to assume a soft diet and reported a weight gain of 3 kg, with a significant improvement of the total symptom score and gastric emptying scintigraphy. Nevertheless, this encouraging clinical benefit gradually disappeared after the first year of follow-up. At the beginning of 2017, the patient experienced persistent episodes of vomiting and returned to jejunostomy feeding. The video shows the technique of laparoscopic Roux-en-Y gastrojejunostomy. After adhesiolysis and transhiatal mobilization of the distal gastric conduit, a 50 cm long Roux-en-Y alimentary limb was fashioned and anastomosed to the antrum. Post-operative course was uneventful and a gastrographin swallow study showed a satisfactory emptying of the conduit. At the 3-month follow-up the patient was able to resume a soft oral diet. Laparoscopic Roux-en-Y gastrojejunostomy appears to be safe and effective in treating refractory gastric outlet obstruction following Ivor-Lewis esophagectomy. Disclosure All authors have declared no conflicts of interest.

Near infrared perfusion assessment of gastric conduit during minimally invasive Ivor Lewis esophagectomy

2018 ◽  
Vol 216 (3) ◽  
pp. 524-527 ◽  
Author(s):  
Brian G.A. Dalton ◽  
Abubaker A. Ali ◽  
Marie Crandall ◽  
Ziad T. Awad
Keyword(s):  
Minimally Invasive ◽  
Near Infrared ◽  
Gastric Conduit ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Perfusion Assessment

Novel T-shaped linear-stapled intrathoracic esophagogastric anastomosis for minimally invasive Ivor Lewis esophagectomy.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e15071-e15071
Author(s):  
YiNan Dong ◽  
Liang Zhang ◽  
Nan Sun ◽  
Yi Ren ◽  
YongYu Liu
Keyword(s):  
Minimally Invasive ◽  
Esophagogastric Anastomosis ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy
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