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

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.

RA04.01: PRONE POSITION IN THORACOSCOPIC ESOPHAGECTOMY IMPROVES POSTOPERATIVE OXYGENATION AND REDUCES PULMONARY COMPLICATIONS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 24-25
Author(s):  
Yoshihiro Kakeji ◽  
Dai Otsubo ◽  
Gosuke Takiguchi ◽  
Taro Oshikiri ◽  
Tetsu Nakamura
Keyword(s):  
Pulmonary Function ◽  
Prone Position ◽  
Surgical Procedure ◽  
Body Position ◽  
Lateral Decubitus Position ◽  
Thoracoscopic Esophagectomy ◽  
Respiratory Complications ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus ◽  
Position Group

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.

106 THE HYBRID POSITION IS SUPERIOR TO THE PRONE POSITION FOR THORACOSCOPIC ESOPHAGECTOMY WITH UPPER MEDIASTINAL LYMPHADENECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
H Kikuchi ◽  
Y Hiramatsu ◽  
W Soneda ◽  
S Kawata ◽  
A Hirotsu ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Prone Position ◽  
Operation Time ◽  
Laryngeal Nerve ◽  
Thoracoscopic Esophagectomy ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Paralysis ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus

Abstract   Thoracoscopic esophagectomy (TE) is becoming a common surgical method for esophageal cancer. TE is performed with the patient the left lateral decubitus position, prone position, or hybrid position combining the left lateral decubitus and prone positions. However, only few studies have compared the clinical utility of these TE positions. Methods In our institute, we introduced TE in the prone position (prone TE) in 2014, and have performed TE in the hybrid position (hybrid TE) since March 2017. The present study compared the short-term outcomes of prone TE versus hybrid TE. One-hundred-and-three patients with esophageal or esophagogastric junction cancer who underwent TE between March 2014 and December 2019 were included. Patients were divided into those who underwent prone TE (prone TE group; n = 43) and those who underwent hybrid TE (hybrid TE group; n = 60). Clinicopathological data were retrospectively reviewed and compared between groups. Results There were no differences between groups in age, tumor histology, and tumor location. Compared with the hybrid TE group, the prone TE group had a smaller tumor depth (P < 0.001), lower grade of lymph node metastasis (P = 0.003), and less severe tumor stage (P = 0.001). The operation time for the thoracoscopic procedure was shorter in the hybrid TE group (318.9 vs 249.2 min, P = 0.002). The rate of recurrent laryngeal nerve paralysis (Clavien-Dindo grade I–III) was significantly lower in the hybrid TE group (41.9% vs 11.7%, P < 0.001), whereas there were no differences between groups in the rates of anastomotic leakage, atelectasis, or pneumonia. Conclusion The most significant differences between prone TE and hybrid TE involved the upper mediastinal procedures. In hybrid TE, the motion of the assistant’s forceps causes less interference with the operative field, and the angle at which the operator's forceps approach the upper mediastinal lymph nodes enables the maintenance of appropriate traction. These advantages of hybrid TE appeared to result in a shorter operation time and less recurrent laryngeal nerve paralysis compared with prone TE.

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

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.

Surgical Techniques for Thoracoscopic Esophagectomy at the Left Lateral Decubitus Position

2019 ◽  
Vol 70 (2) ◽  
pp. 197-197
Author(s):  
H. Sato ◽  
Y. Miyawaki ◽  
N. Fujiwara ◽  
H. Sugita ◽  
M. Aikawa ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Lateral Decubitus Position ◽  
Thoracoscopic Esophagectomy ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus

221 THORACOSCOPIC ESOPHAGECTOMY WITH OR WITHOUT SMALL THORACOTOMY FOR ADVANCED THORACIC ESOPHAGEAL CARCINOMA IN THE LEFT LATERAL DECUBITUS POSITION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Hiroshi Sato ◽  
Yutaka Miyawaki ◽  
Naoto Fujiwara ◽  
Hirofumi Sugita ◽  
Shinichi Sakuramoto ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Salvage Surgery ◽  
Thoracoscopic Surgery ◽  
Lateral Decubitus Position ◽  
Thoracoscopic Esophagectomy ◽  
Definitive Chemoradiotherapy ◽  
Left Lateral Decubitus Position ◽  
Artificial Pneumothorax ◽  
Lateral Decubitus ◽  
Upper Mediastinum

Abstract   Standardized thoracoscopic esophagectomy for thoracic esophageal carcinoma in the left lateral decubitus position under artificial pneumothorax is slightly more difficult to dissect the middle and lower mediastinum than in prone position, but it is possible to operate the upper mediastinum with good visual field. In salvage surgery after definitive chemoradiotherapy, it is difficult to complete the operation only by throscopic surgery, and it is thought that sometimes small thoracotomy can be performed safely and reliably. Methods If this procedure is considered feasible, start with thoracoscopic surgery. If it is decided that the procedure cannot be completed, add a small thoracotomy of about 10–15 cm to allow one hand. Thoracoscopy not only reduced invasiveness, shared detailed anatomy, but also improved operability by taping the esophagus and ensured emergency safety. Results This standardized procedure is applied to salvage surgery after definitive chemoradiotherapy from January 2016 to March 2019. Thoracoscopic surgery was performed in 14 of the 27 cases (52%). Thoracoscopic surgery was completed in 10 cases and small thoracotomy was used in 4 cases. There are no serious complications such as bleeding. Conclusion Starting surgery with a thoracoscopy and adding small thoracotomy as appropriate can share the advantages of thoracotomy and throcoscopic surgery. This technique has the advantage that it can be easily converted to thoracotomy even in an emergency, and is considered to be superior to advanced cancer. Video https://www.dropbox.com/sh/47jcqu3palpsfvg/AAC4PvReWDP_WPBkJufxWU3da?dl=0.

PS02.013: THORACOSCOPIC ESOPHAGECTOMY WITH RADICAL LYMPH NODE DISSECTION FOR THORACIC ESOPHAGEAL CARCINOMA IN THE LEFT LATERAL DECUBITUS POSITION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 124-124
Author(s):  
Hiroshi Sato ◽  
Yutaka Miyawaki ◽  
Masayasu Aikawa ◽  
Kojun Okamoto ◽  
Shinichi Sakuramoto ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Laryngeal Nerve ◽  
Lateral Decubitus Position ◽  
Thoracoscopic Esophagectomy ◽  
Mediastinal Lymph Nodes ◽  
Node Dissection ◽  
Co2 Insufflation ◽  
Left Lateral Decubitus Position ◽  
Artificial Pneumothorax ◽  
Lateral Decubitus

Abstract Background The rates of thoracoscopic esophagectomy performed in the prone and left lateral decubitus positions are similar in Japan. We retrospectively reviewed short term outcomes of thoracoscopic esophagectomy for esophageal cancer performed in the left lateral decubitus position under artificial pneumothorax by CO2 insufflation in a single institution. This study aimed to evaluate the feasibility of applying this procedure. Methods Between July 2013 and March 2017, 83 patients with esophageal cancer underwent thoracoscopic esophagectomy in the left lateral decubitus position under artificial pneumothorax by CO2 insufflation. The thoracic procedure is performed as follows: The lymph nodes around the right recurrent laryngeal nerve are dissected. On the cranial side, the lymph node dissection is advanced to the level of the inferior thyroid artery. Then, the assistant rotates the trachea toward the ventral side, and the lymph nodes around the left recurrent laryngeal nerve are dissected. The middle and inferior mediastinal lymph nodes are dissected including supradiaphragmatic lymph nodes and the dorsal lymph nodes around the thoracic descending aorta. Then, the esophagus is transected using an automatic suture device. Finally, the tracheal bifurcation area lymph nodes are dissected. We retrospectively analyzed these patients. Results The completion rate of thoracoscopic esophagectomy was 94.0%, and the procedure was converted to thoracotomy in five patients, due to hemorrhage, severe adhesion. The mean intrathoracic operative time, intrathoracic blood loss, and number of dissected mediastinal lymph nodes were 220.0 min, 130.1 mL, and 22.0, respectively. Postoperative complications included pneumonia (8.4%), anastomotic leakage (16.9%), and recurrent nerve paralysis (8.4%). Postoperative (30d) mortality was 1/83 (1.2%) due to ARDS. Conclusion Standardization of the procedure for thoracoscopic esophagectomy in the left lateral decubitus position under artificial pneumothorax by CO2 insufflation, with a standardized clinical pathway for perioperative care led to favorable surgical outcomes. Disclosure All authors have declared no conflicts of interest.

212 USEFULNESS OF ENDOSCOPIC ESOPHAGECTOMY IN A PRONE POSITION FOR ELDERLY PATIENTS OVER 75 YEARS OLD

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Ken Ito ◽  
Takashi Kamei ◽  
Masahiro Chin ◽  
Motohisa Hagiwara ◽  
Yasuyuki Hara ◽  
...  
Keyword(s):  
Blood Loss ◽  
Nutritional Status ◽  
Prone Position ◽  
Operation Time ◽  
Lateral Position ◽  
Recurrent Nerve ◽  
Swallowing Function ◽  
Nerve Paralysis ◽  
Number Of Patients ◽  
Recurrent Nerve Paralysis

Abstract   Surgery for esophageal squamous cell carcinoma(ESCC) is one of the most invasive surgery and high mortality rate because operation is centered on the thoracic cavity. Recently, Japan has been facing aging society, and surgery for elderly ESCC patient is increasing. In our hospital, we changed surgical position from left lateral position to prone. In this study, we investigated the surgical outcome and prognosis of ESCC operation in the patients aged ≧ 75. Methods From April 2011 to March 2019, 39 ESCC operations for patients aged ≧ 75 were performed in our hospital. We compered surgical position. We retrospectively examined clinicopathological factors, long-term prognosis, preoperative nutritional status (albmin, neutrophil and lymphocyte ratio), and operation factors (operation time, blood loss, recurrent nerve paralysis, complication, hospital stay). Results Cases in lateral position surgery were 22 and prone position were 17. The median age was 79 vs 79 years old, and the gender ratio was male: female = 16:6/14:3. No significant differences were observed in preoperative nutritional status. The operation time was 458 min vs 501 min (p = 0.126). The blood loss was 318 mL vs 195 mL (p = 0.003). The rate of recurrent nerve paralysis was 42.1% vs 29.4% (p = 0.262). The number of patients in Clavien-Dindo ≧ III complications was 40.9% vs 41.2% (p = 0.987). 3-year OS was 74.7% vs 77.3%, DFS was 78.6% vs 67.7%. Conclusion In ESCC patients aged ≧ 75, surgery in prone position was relatively safe. The blood loss and the recurrent nerve paralysis ware tend to be less. Recurrent nerve monitoring during operation and evaluation of perioperative swallowing function seemed to be the next subject.

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