Minimally-invasive subtotal oesophagectomy: three-stage thoracoscopic, laparoscopic subtotal oesophagectomy with cervical anastomosis

2011 ◽  
Vol 2011 (0516) ◽  
Author(s):  
R. G. Berrisford
Keyword(s):  
Minimally Invasive ◽  
Cervical Anastomosis

Prospective Comprehensive Swallowing Evaluation of Minimally Invasive Esophagectomies with Cervical Anastomosis: Silent Versus Vocal Aspiration

2015 ◽  
Vol 19 (10) ◽  
pp. 1748-1752 ◽  
Author(s):  
Kfir Ben-David ◽  
Amy Fullerton ◽  
Georgios Rossidis ◽  
Michael Michel ◽  
Ryan Thomas ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cervical Anastomosis ◽  
Swallowing Evaluation

477 MINIMALLY INVASIVE MEDIASTINOSCOPIC IVOR-LEWIS ESOPHAGECTOMY WITH CERVICAL ANASTOMOSIS FOR ESOPHAGOGASTRIC JUNCTION ADENOCARCINOMA PATIENT UNDER INTRAOPERATIVE RECURRENT LARYNGEAL NERVE MONITORING

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Akihiro Suzuki ◽  
Kazuhiko Mori ◽  
Shuntaro Hirose ◽  
Jo Tashiro ◽  
Taketo Matsubara ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Recurrent Laryngeal Nerve ◽  
Esophagogastric Junction ◽  
Laryngeal Nerve ◽  
Cervical Anastomosis ◽  
Nerve Monitoring ◽  
Ivor Lewis ◽  
Less Invasive ◽  
Ivor Lewis Esophagectomy ◽  
Made In

Abstract   In early 2000s, cervical anastomosis after esophagectomy was associated with a higher rate of recurrent nerve trauma than thoracic anastomosis. Recently, new technologies have been developed that reduce surgical complications. Mediastinoscopic esophagectomy is reportedly less invasive and allows faster recovery than thoracoscopic esophagectomy. Intraoperative nerve monitoring (IONM) prevents recurrent laryngeal nerve (RNL) palsy. We present the case of minimally invasive mediastinoscopic Ivor-Lewis Esophagectomy (MMIE) under IONM performed on an elderly esophagogastric junction (EGJ) adenocarcinoma patient. Methods An 84-year old man was consulted for adenocarcinoma of GEJ without lymphnode metastasis. Despite his advanced age, he had no comorbidities. We planned to perform MMIE under IONM. The procedure started with a patient lithotomy, and three trocars plus small incision were made in the upper abdomen. Celiac lymphadenectomy was performed. Subsequently, a 35 mm incision was made in the left side of the neck and a monitor was attached to left vagus nerve. Three trocars were placed with single incision surgical devices and pneumomediastinum was noticed. Mediastinoscopic esophagectomy was performed. Gastric tube reconstruction via mediastinum with cervical anastomosis was performed. Results The operation was successful. Total operation time was 393 minutes, with an estimated blood loss of 5 mL. There were no intraoperative and postoperative complications, and no RLN palsy occurred. Conclusion MMIE with cervical anastomosis under IONM is safe and less invasive especially for the respiratory system as a thoracotomy is unnecessary. Video https://www.dropbox.com/s/9yqkzg3pm619pf6/%E7%B8%A6%E9%9A%94%E9%8F%A12%E5%88%8656%E7%A7%92.mp4?dl=0.

scholarly journals Improved Functional Results After Minimally Invasive Esophagectomy: Intrathoracic Versus Cervical Anastomosis

2017 ◽  
Vol 103 (1) ◽  
pp. 267-273 ◽  
Author(s):  
Frans van Workum ◽  
Jolijn van der Maas ◽  
Frits J.H. van den Wildenberg ◽  
Fatih Polat ◽  
Ewout A. Kouwenhoven ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Functional Results ◽  
Cervical Anastomosis ◽  
Invasive Esophagectomy

RA04.07: A NOVEL TECHNIQUE FOR CERVICAL GASTROESOPHAGEAL ANASTOMOSIS DURING MINIMALLY INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 26-26
Author(s):  
Yuequan Jiang
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Minimally Invasive Esophagectomy ◽  
Occurrence Rate ◽  
Controlled Study ◽  
Cervical Anastomosis ◽  
Anastomotic Technique ◽  
Invasive Esophagectomy ◽  
Postoperative Leakage

Abstract Background Anastomotic leakage, fibrous stricture and gastroesophageal reflux are three major complications of gastroesophageal anastomosis, particularly in cervical anastomosis. Our aim was to evaluate the safety and efficacy of a novel cervical anastomosis technique (NA) by comparing it to the traditional side-to-side anastomosis (SS), and the end-to-side anastomosis using a circular stapler (CS) in terms of postoperative leakage, stricture and reflux. Methods A total of 390 patients with thoracic esophageal cancer underwent a minimally invasive esophagectomy with cervical anastomosis (192 with NA, 34 with SS and 164 with CS) in our institute from January 2013 and May 2016. The new anastomotic technique was improved from a type of side-to-side anastomosis technique which was reported by Collard et al. The difference of our new technique is that the part of the anastomotic stump was pushed into the tubular stomach. It let the end part of esophagus was embedded in the gastric tube while the end portion of the stomach was also reversed into the gastric tube (figure 1, 2, 3). The major postoperative complications including postoperative leakage, stricture and reflux were compared using three armed controlled study. Results With regard to the incidence of anastomotic leakage and reflux, the patients who underwent Jiang's anastomosis had a significantly lower rate than those in the SS group and CS group (Leaks: 1.0% vs. 8.8% and 8.5%, P = 0.025, 0.001; Reflux: 5.7% vs. 23.5% and 18.3%, P = 0.003, 0.001). The incidence of dysphagia was 10.4% with an occurrence rate of 1.5% for anastomotic strictures in the NA group. It was significant lower than that in the CS group (41.5% vs. 18.9%, P < 0.05) but not significantly different from that in SS group (11.8% vs. 2.9%). Conclusion The novel anastomotic technique remarkably reduced the incidence of gastroesophageal-anastomotic leakage, stricture and reflux and was a safe and effective technique for minimally invasive esophagectomy. Disclosure All authors have declared no conflicts of interest.

P113 ESOPHAGECTOMY-SPECIFIC OBJECTIVE STRUCTURED ASSESSMENT OF TECHNICAL SKILL (E-OSATS): CONSENSUS ON ESSENTIAL IVOR-LEWIS AND MCKEOWN STEPS TROUGH DELPHI METHODOLOGY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Yassin Eddahchouri ◽  
Workum Frans van ◽  
Bastiaan Klarenbeek ◽  
den Wildenberg Frits van ◽  
Berge Henegouwen Mark van ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Learning Curve ◽  
Assessment Tool ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Cervical Anastomosis ◽  
International Consensus ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Specific Objective

Abstract Aim The objective of this study was to determine expert consensus on essential steps in MIE to develop an ‘Esophagectomy-specific Objective Structured Assessment of Technical Skills’ tool (E-OSATS). Background & Methods Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure. Studies have shown that MIE has a long learning curve which is associated with increased morbidity and mortality. To master MIE training of procedural steps is crucial. Yet, no consensus regarding the essential steps nor a structured way of assessment of MIE are available. Essential steps were defined for both Ivor-Lewis (IL) and McKeown (MCK) approach, based on expert opinion and peer-reviewed literature. In round table discussions experts finalized the list, and an online Delphi questionnaire was sent to an international expert panel (7 European countries) of minimally invasive upper GI surgeons. Based on replies and comments steps were adjusted and rephrased and sent in iterative fashion until consensus was achieved. Results Two Delphi rounds were conducted, and response rates were 74% (23 out of 31 experts) for the first and 81% (27 out of 33 experts) for the second round. Consensus was achieved on 94 and 98 steps for the IL and MCK approach respectively. Cronbach’s alpha in the first round was 0,77 (IL) and 0,77 (MCK), and in the second round 0,91 (IL) and 0,87 (MCK). Conclusion International consensus on essential surgical steps for MIE with both intrathoracic- and cervical anastomosis was achieved. Validation of the assessment tool allows for specific and structured feedback and will potentially shorten the learning curve and decrease learning associated morbidity consequently.

PS01.246: ESOPHAGECTOMY-SPECIFIC OBJECTIVE STRUCTURED ASSESSMENT OF TECHNICAL SKILL (E-OSATS): CONSENSUS ON ESSENTIAL STEPS THROUGH DELPHI METHODOLOGY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 119-119
Author(s):  
Yassin Eddahchouri ◽  
Suzanne Gisbertz ◽  
Mark I Van Berge Henegouwen ◽  
Bastiaan Klarenbeek ◽  
Camiel Rosman
Keyword(s):  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Round Table Discussion ◽  
Cervical Anastomosis ◽  
Invasive Esophagectomy ◽  
Delphi Round ◽  
Specific Objective ◽  
International Experts

Abstract Background Minimally invasive esophagectomy (MIE) is a technically demanding procedure, but without consensus regarding essential steps and assessment of surgical technique. The objective of this study was to determine expert consensus on essential steps in MIE as a first step in the development of an ‘esophagectomy-specific objective structured assessment of technical skills’ tool (E-OSATS). Methods Essential steps were defined for both MIE with intrathoracic- and cervical anastomosis, based on local expert opinion, peer-reviewed literature and surgical textbooks. In round table discussion disparities between experts were resolved, and an online Delphi questionnaire was sent to an international expert panel of minimally invasive upper GI surgeons. Based on replies and comments steps were adjusted and resent in iterative fashion. Results A total of 137 and 138 essential steps were identified for the MIE with intrathoracic- and cervical anastomosis respectively. After the first Delphi round 24 out of 36 (67%) invited international experts replied, and consensus was reached in 99 out of 137 (72%) and 95 out of 138 steps for both procedures respectively. Conclusion A Delphi method seems feasible in determining essential steps as a first step in the development of an E-OSATS for both MIE with intrathoracic- and cervical anastomosis. The second Delphi round is currently pending. Disclosure All authors have declared no conflicts of interest.

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