scholarly journals P191 MINIMALLY-INVASIVE ESOPHAGECTOMY IN TREATMENT FOR ESOPHAGEAL DISEASES

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Usenko Oleksandr ◽  
Sydiuk Andriy ◽  
Sydiuk Olena ◽  
Savenko Georgiy ◽  
Klimas Andriy
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Intestinal Obstruction ◽  
Hospital Stay ◽  
Operative Time ◽  
Minimally Invasive Esophagectomy ◽  
Transhiatal Esophagectomy ◽  
Gastric Conduit ◽  
Invasive Esophagectomy ◽  
Average Operative Time

Abstract Aim to study the benefits of the mini-invasive approach. Background & Methods 115 esophagectomies were performed for the period from 2015 to 2018. Gastric conduit in 84 patients, colon - 2 and small intestine - 29. The study included 65 patients after I.Lewis, McKeown or transhiatal esophagectomy, who was performed esophageal replacement with gastric conduit. The first group consisted of 44 patients after open esophagectomy; second group - 21 patients after MIE (minimally invasive esophagectomy): included 8 patients - thoraco-laparoscopic McKeown surgery, 1 patient - laparoscopic transhiatal esophagectomy with anastomosis on the neck, 9 patients – hybrid minimally invasive I.Lewis surgery (laparoscopy+thoracotomy), and 3 patients – minimally invasive thoraco-laparoscopic I.Lewis surgery. The average age of patients was 53 years (13-64). 55 patients (84.6%) with esophageal cancer and 10 patients (15.4%) with benign strictures of the esophagus. There were anastomosis on the neck in 28 patients (43%) and intrathoracic anastomosis in 37 patients (57%). Results In the first group the average operative time was 286 minutes (240-370 min.), the average volume of blood loss was 345 ml (100-600 ml), the length of in-hospital stay was 15 days (9-29), complications: anastomosis leakage - 1 patient on the 5th postoperative day - EndoVAC system was used with a defect closure after 18 days; 1 patient - adhesive intestinal obstruction (relaparotomy, separation of adhesions). In the second group the average operative time was 400 min (370-480 min.), blood loss - 100 ml (50-200 ml), the length of in-hospital stay - 10 days (8-16), complications in 1 patient - acute strangulation with intestinal obstruction. There was no mortality in both groups. Conclusions The application of MIE helps to reduce the severity of postoperative pain, the length of in-hospital stay and intraoperative blood loss. This procedure should be performed in specialized hospitals with experience in miniinvasive surgery and esophageal surgery.

PS01.225: SINGLE HOLE PNEUMOPERITONEUM COMBINED WITH LAPAROSCOPIC RADICAL MASTECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 114-114
Author(s):  
Hua Tang ◽  
Kenan Huang ◽  
Xinyu Ding ◽  
Bin Wu ◽  
Zhifei Xu
Keyword(s):  
Esophageal Cancer ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Operative Time ◽  
Conflicts Of Interest ◽  
Single Port ◽  
Minimally Invasive Esophagectomy ◽  
Radical Mastectomy ◽  
Invasive Esophagectomy ◽  
Laparoscopic Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) has been an alternative treatment for esophageal cancer. The objective of this study is to evaluate the safety and feasibility of single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy for esophageal cancer. Methods Retrospective analysis of clinical data was performed on 12 patients with esophageal cancer who underwent a single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy by one surgical team in Shanghai Changzheng hospital. Recorded outcome measures included operative time, blood loss, length of hospital stay, and perioperative complications. Results No perioperative mortality, pulmonary infection, arrhythmia, recurrent laryngeal nerve (RLN) palsy and thoracic duct injury was observed in all patients. The operative time, intraoperative blood loss and pressure of CO2 was (219 ± 9.3)min, (26.3 ± 2.7)ml and (50.5 ± 4.6)mmHg. The mean number of dissected thoracic lymph nodes was 19 ± 1.5. One patient was converted to open surgery because of massive bleeding intraoperation. Two patients occurred postoperative anastomotic leakage. Conclusion A single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy provides safe and feasible approach to minimally invasive esophagectomy for patients with early esophageal cancer. Disclosure All authors have declared no conflicts of interest.

Minimally Invasive Esophagectomy with Right Bronchial Occlusion under Artificial Pneumothorax

2015 ◽  
Vol 32 (2) ◽  
pp. 77-81 ◽  
Author(s):  
Yi Zhang ◽  
RuiHua Duan ◽  
XiangFeng Xiao ◽  
Tiecheng Pan
Keyword(s):  
Minimally Invasive ◽  
Esophageal Carcinoma ◽  
Prone Position ◽  
Operative Time ◽  
Minimally Invasive Esophagectomy ◽  
Subtotal Esophagectomy ◽  
Invasive Esophagectomy ◽  
Artificial Pneumothorax ◽  
Average Operative Time ◽  
The Right

Aims: To assess the safety and feasibility of minimally invasive esophagectomy and selected three-field lymphadenectomy with the right bronchial occlusion in left semi-prone position under artificial pneumothorax. Methods: Thoracoscopic-laparoscopic subtotal esophagectomy and selected three-field lymphadenectomy were performed in 166 patients with esophageal carcinoma by the right bronchial occlusion in left semi-prone position under artificial pneumothorax. Results: 109 patients received two-field lymphadenectomy and 57 received three-field lymphadenectomy. The average operative time was 202.5 ± 21.3 min; the average thoracoscopic operative time was 98.4 ± 15.5 min. The average blood loss was 39.6 ± 4.2 ml, and no blood transfusion was needed during the surgery. The mean lymph node harvest was 28.4 ± 5.2 nodes. Hospital stay ranged from 7 to 95 days and the average was 11.3 days. The postoperative complication rate was 29.5%, and the mortality rate was 1.2%. Conclusions: It is feasible and safe to perform thoracoscopic-laparoscopic subtotal esophagectomy and selected three-field lymphadenectomy with the right bronchial occlusion in left semi-prone position under artificial pneumothorax for esophageal carcinoma. The procedure shows advantages in improved visibility and accessibility of the surgical field, and better subsequent surgical outcomes.

384 SHORT-TERM OUTCOMES OF INTRA-THORACIC ESOPHAGO-GASTRIC ANASTOMOSES UNDER MINIMALLY INVASIVE ESOPHAGECTOMY VIA A PRONE POSITION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Shinji Mine ◽  
Masayuki Watanabe ◽  
Atushi Kanamori ◽  
Yu Imamura ◽  
Akihiko Okamura ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Stricture ◽  
Minimally Invasive Esophagectomy ◽  
Anterior Wall ◽  
Gastric Conduit ◽  
Linear Stapler ◽  
Short Term ◽  
Invasive Esophagectomy ◽  
Operative Complications ◽  
Gastric Anastomosis

Abstract   Although minimally invasive esophagectomy (MIE) has been performed for esophageal cancer worldwide, intra-thoracic anastomosis under prone positions is still challenging. In this retrospective study, we reviewed our short-term results of this anastomotic technique in our institution. Methods From November 2016 to December 2019, we performed 319 esophagectomies. Of these patients, 28 patients (9%) underwent intra-thoracic esophago-gastric anastomosis under MIE. Procedures The left side of an esophageal stump which had been closed using a linear stapler was opened for anastomosis. Then, the anterior wall of a gastric conduit, around 5 cm below the tip, was opened for anastomosis. Linear staplers were inserted in both esophageal stump and gastric conduit and side-to-side anastomosis was performed. The opening for insertion was closed using a hand-sewn anastomosis in 2 layers. Results Five patients (18%) suffered anastomotic leakage with Clavien-Dindo 2 and 3a, and all of them recovered by conservative treatments. Two patients (2/19, 11%) showed anastomotic stricture which improved by several endoscopic dilatations. Six patients (6/19, 32%) showed the reflux esophagitis of Grade C. Conclusion Although we have not experienced severe or critical post-operative complications, the short-term results of intra-thoracic anastomosis under MIE were not sufficient. Additional progresses in techniques are required.

Costs and benefits of different methods of esophagectomy for esophageal cancer

2017 ◽  
Vol 25 (7-8) ◽  
pp. 513-517 ◽  
Author(s):  
Alongkorn Yanasoot ◽  
Kamtorn Yolsuriyanwong ◽  
Sakchai Ruangsin ◽  
Supparerk Laohawiriyakamol ◽  
Somkiat Sunpaweravong
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Pain ◽  
Minimally Invasive ◽  
Operative Time ◽  
Minimally Invasive Esophagectomy ◽  
Laparoscopic Approach ◽  
Costs And Benefits ◽  
Invasive Approach ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy

Background A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of the costs and benefits of minimally invasive, hybrid, and open esophagectomy approaches for esophageal cancer surgery. Methods The data of 83 consecutive patients who underwent a McKeown’s esophagectomy at Prince of Songkla University Hospital between January 2008 and December 2014 were analyzed. Open esophagectomy was performed in 54 patients, minimally invasive esophagectomy in 13, and hybrid esophagectomy in 16. There were no differences in patient characteristics among the 3 groups Minimally invasive esophagectomy was undertaken via a thoracoscopic-laparoscopic approach, hybrid esophagectomy via a thoracoscopic-laparotomy approach, and open esophagectomy by a thoracotomy-laparotomy approach. Results Minimally invasive esophagectomy required a longer operative time than hybrid or open esophagectomy ( p = 0.02), but these patients reported less postoperative pain ( p = 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 3 groups. Minimally invasive esophagectomy incurred higher operative and surgical material costs than hybrid or open esophagectomy ( p = 0.01), but there were no significant differences in inpatient care and total hospital costs. Conclusion Minimally invasive esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain. Hybrid esophagectomy had a shorter learning curve while sharing the advantages of minimally invasive esophagectomy.

P175 TRANSLATION OF MINIMALLY INVASIVE ESOPHAGECTOMY FROM RANDOMIZED CONTROLLED TRIAL SETTING (TIME) TO NATIONAL PRACTICE (DUCA) IN NETHERLANDS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R Markar Sheraz ◽  
Ni Melody ◽  
Gisbertz Suzanne ◽  
Straatman Jennifer ◽  
van der Peet Donald ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Time Trial ◽  
Reoperation Rate ◽  
Invasive Esophagectomy

Abstract Aims The TIME trial showed reduced pulmonary complications from minimally invasive esophagectomy (MIE) over an open approach, and led to widespread adoption of MIE in the Netherlands. The aim of this study was to compare clinical outcomes from minimally invasive esophagectomy in the DUCA (national dataset) and the TIME trial (RCT) for transthoracic esophagectomy1. Methods Original patient data from the TIME trial1 was extracted along-with data from the Dutch National Cancer Audit (DUCA) (2011-2017). Initially univariate analysis was used to compare patient and tumor demographics and clinical and pathological outcomes from patients receiving MIE in the TIME trial and in the DUCA-dataset. Secondly multivariate analysis, with adjustment patient and tumor factors, was performed for the effect of MIE vs. Open esophagectomy on clinical outcomes in both datasets. Thirdly the datasets were combined and multivariate analysis, was performed for the effect of patient inclusion in TIME trial or DUCA-dataset. Results 115 patients from TIME (59 MIE vs. 56 open) and 4605 patients from the DUCA-dataset (2652 MIE vs. 1953 open) were included. Univariate analysis showed, in TIME trial, MIE reduced postoperative complications and length of hospital stay. However in the DUCA-dataset, MIE increased postoperative complications, re-intervention rate and length of hospital stay, however pathological benefits included increased proportion of R0 margin and lymph nodes harvested. Multivariate analysis confirmed the TIME data showed MIE reduced postoperative complications (OR=0.38, 95%CI 0.16–0.90). In the DUCA-dataset, MIE was associated with increased postoperative complications (OR=1.37, 95%CI 1.20–1.55), re-intervention (OR=1.84, 95%CI 1.57–2.14), and length of hospital stay (Coeff=1.57, 95%CI 0.06–3.08). Pathological benefits to MIE in the DUCA-dataset included a reduction in proportion of R1 margin, and increased lymph node harvest. Multivariate analysis of the combined dataset, showed inclusion in the TIME trial was associated with a reduction in postoperative complications (OR=0.23, 95%CI 0.15–0.36) and reoperation rate (OR=0.34, 95%CI 0.17–0.66). Conclusions MIE when adopted nationally outside the TIME-trial, was associated with an increase in postoperative complications and reoperation rate, which may reflect surgeons on a national level going through their proficiency-gain curve in the technique and outside of expert MIE centers.

Classification and early recognition of gastric conduit failure after minimally invasive esophagectomy

2008 ◽  
Vol 23 (9) ◽  
pp. 2110-2116 ◽  
Author(s):  
Darmarajah Veeramootoo ◽  
Rajeev Parameswaran ◽  
Rakesh Krishnadas ◽  
Peter Froeschle ◽  
Martin Cooper ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Early Recognition ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Conduit ◽  
Invasive Esophagectomy

Extracorporeal Gastric Stapling Reduces the Incidence of Gastric Conduit Failure after Minimally Invasive Esophagectomy

2010 ◽  
Vol 76 (8) ◽  
pp. 823-828 ◽  
Author(s):  
Gregory D. Crenshaw ◽  
Suven S. Shankar ◽  
Russell E. Brown ◽  
Abbas E. Abbas ◽  
John S. Bolton
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Operative Mortality ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Conduit ◽  
Short Term ◽  
Simple Modification ◽  
Invasive Esophagectomy ◽  
Clinic Foundation ◽  
Significant Difference

Esophageal cancer resection is associated with significant morbidity and mortality. To date, no standardized technique exists. In this study, we analyze our short-term results in 92 minimally invasive resections performed over the past 10 years in an attempt to identify technical factors, which contribute to improved short-term outcomes. A retrospective review of 92 minimally invasive esophagectomies was performed at the Ochsner Clinic Foundation from 1999 through 2009. Data collected included preoperative stage, whether or not preoperative chemoradiation was used, technique of minimally-invasive resection, technique of esophagogastric anastomosis, margin status, anastomotic leak, conduit necrosis, gastric conduit failure of any type, and operative mortality. Gastric stapling was done either laparoscopically (intracorporeal) or through a minilaparotomy (extracorporeal). Ninety-two patients met criteria for this study. There was a significant difference in the incidence of positive gastric margins ( P = 0.04), anastomotic leak ( P = 0.045), conduit necrosis ( P = 0.03), and any gastric conduit failure ( P = 0.02) favoring the extracorporeal group. The overall short-term morbidity and operative mortality with minimally invasive esophagectomy is comparable to the results obtained with open techniques. A relatively simple modification of the operative technique—performing extracorporeal stapling of the gastric conduit—led to a significant reduction in the incidence of gastric conduit failures when compared with the intracorporeal stapling technique.

scholarly journals Implementation of Minimally Invasive Esophagectomy From a Randomized Controlled Trial Setting to National Practice

2020 ◽  
Vol 38 (19) ◽  
pp. 2130-2139 ◽  
Author(s):  
Sheraz R. Markar ◽  
Melody Ni ◽  
Suzanne S. Gisbertz ◽  
Leonie van der Werf ◽  
Jennifer Straatman ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Time Trial ◽  
Pulmonary Complications ◽  
Invasive Technique ◽  
Invasive Esophagectomy

PURPOSE The aim of this study was to examine the external validity of the randomized TIME trial, when minimally invasive esophagectomy (MIE) was implemented nationally in the Netherlands, using data from the Dutch Upper GI Cancer Audit (DUCA) for transthoracic esophagectomy. METHODS Original patient data from the TIME trial were extracted along with data from the DUCA dataset (2011-2017). Multivariate analysis, with adjustment for patient factors, tumor factors, and year of surgery, was performed for the effect of MIE versus open esophagectomy on clinical outcomes. RESULTS One hundred fifteen patients from the TIME trial (59 MIE v 56 open) and 4,605 patients from the DUCA dataset (2,652 MIE v 1,953 open) were included. In the TIME trial, univariate analysis showed that MIE reduced pulmonary complications and length of hospital stay. On the contrary, in the DUCA dataset, MIE was associated with increased total and pulmonary complications and reoperations; however, benefits included increased proportion of R0 margin and lymph nodes harvested, and reduced 30-day mortality. Multivariate analysis from the TIME trial showed that MIE reduced pulmonary complications (odds ratio [OR], 0.19; 95% CI, 0.06 to 0.61). In the DUCA dataset, MIE was associated with increased total complications (OR, 1.36; 95% CI, 1.19 to 1.57), pulmonary complications (OR, 1.50; 95% CI, 1.29 to 1.74), reoperations (OR, 1.74; 95% CI, 1.42 to 2.14), and length of hospital stay. Multivariate analysis of the combined and MIE datasets showed that inclusion in the TIME trial was associated with a reduction in reoperations, Clavien-Dindo grade > 1 complications, and length of hospital stay. CONCLUSION When adopted nationally outside the TIME trial, MIE was associated with an increase in total and pulmonary complications and reoperation rate. This may reflect nonexpert surgeons outside of high-volume centers performing this minimally invasive technique in a nonstandardized fashion outside of a controlled environment.

The Hand-Assisted Laparoscopic Approach to Resection of Pancreatic Mucinous Cystic Neoplasms: An Underused Technique?

2018 ◽  
Vol 84 (1) ◽  
pp. 56-62
Author(s):  
Lauren M. Postlewait ◽  
Cecilia G. Ethun ◽  
Mia R. Mcinnis ◽  
Nipun Merchant ◽  
Alexander Parikh ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Distal Pancreatectomy ◽  
Operative Time ◽  
Operative Blood Loss ◽  
Specimen Length ◽  
Cystic Neoplasms ◽  
Invasive Approach ◽  
Mucinous Cystic Neoplasms

Pancreatic mucinous cystic neoplasms (MCNs) are rare tumors typically of the distal pancreas that harbor malignant potential. Although resection is recommended, data are limited on optimal operative approaches to distal pancreatectomy for MCN. MCN resections (2000–2014; eight institutions) were included. Outcomes of minimally invasive and open MCN resections were compared. A total of 289 patients underwent distal pancreatectomy for MCN: 136(47%) minimally invasive and 153(53%) open. Minimally invasive procedures were associated with smaller MCN size (3.9 vs 6.8 cm; P = 0.001), lower operative blood loss (192 vs 392 mL; P = 0.001), and shorter hospital stay(5 vs 7 days; P = 0.001) compared with open. Despite higher American Society of Anesthesiologists class, hand-assisted (n = 46) had similar advantages as laparoscopic/robotic (n = 76). When comparing hand-assisted to open, although MCN size was slightly smaller (4.1 vs 6.8 cm; P = 0.001), specimen length, operative time, and nodal yield were identical. Similar to laparoscopic/robotic, hand-assisted had lower operative blood loss (161 vs 392 mL; P = 0.001) and shorter hospital stay (5 vs 7 days; P = 0.03) compared with open, without increased complications. Hand-assisted laparoscopic technique is a useful approach for MCN resection because specimen length, lymph node yield, operative time, and complication profiles are similar to open procedures, but it still offers the advantages of a minimally invasive approach. Hand-assisted laparoscopy should be considered as an alternative to open technique or as a successive step before converting from total laparoscopic to open distal pancreatectomy for MCN.

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