scholarly journals Factors Affecting Blood Loss During Thoracoscopic Esophagectomy for Esophageal Carcinoma

2021 ◽  
Author(s):  
Masayuki Urabe ◽  
Yu Ohkura ◽  
Shusuke Haruta ◽  
Masaki Ueno ◽  
Harushi Udagawa
2019 ◽  
Vol 28 (6) ◽  
pp. e165-e174 ◽  
Author(s):  
Dominik Malcherczyk ◽  
Antonio Klasan ◽  
Arne Ebbinghaus ◽  
Brandon Greene ◽  
Martin Bäumlein ◽  
...  

2010 ◽  
Vol 24 (2) ◽  
pp. 207-211 ◽  
Author(s):  
Jeffrey J. Tomaszewski ◽  
Marc C. Smaldone ◽  
Tina Schuster ◽  
Stephen V. Jackman ◽  
Timothy D. Averch

2021 ◽  
Vol 10 (13) ◽  
pp. 2930
Author(s):  
Sa Ra Lee ◽  
Ju Hee Kim ◽  
Sehee Kim ◽  
Sung Hoon Kim ◽  
Hee Dong Chae

To identify factors affecting blood loss and operation time (OT) during robotic myomectomy (RM), we reviewed a total of 448 patients who underwent RM at Seoul Asan Hospital between 1 January 2019, and 28 February 2021, at Seoul Asan Hospital. To avoid variations in surgical proficiency, only 242 patients managed by two surgeons who each performed >80 RM procedures during the study period were included in this study. All cases of RM were performed with a reduced port technique. We obtained the following data from each patient’s medical chart: age, gravidity, parity, body mass index, and history of previous abdominal surgery including cesarean section. We also collected information on the maximal diameter and type of myomas, number and weight of removed myomas, concomitant surgery, total OT from skin incision to closure, estimated blood loss (EBL), and blood transfusion. Data on preoperative use of gonadotropin-releasing hormone agonists (GnRHas) and perioperative use of hemostatic agents (tranexamic acid or vasopressin) were also collected. Data on the length of hospital stay, postoperative fever within 48 h, and any complications related to RM were also obtained. The primary endpoint in this study was the identification of factors affecting EBL and the secondary endpoint was the identification of factors affecting the total OT during multiport RM. Univariate and multivariate analyses were used to identify the factors affecting EBL and OT during multiport RM. The medians of the maximal diameter and weight of the removed myomas were 9.00 (interquartile range [IQR], 7.00 to 10.00) cm and 249.75 (IQR, 142.88 to 401.00) g, respectively. The median number of myomas was two (IQR, one to four), ranging from 1 to 34. Of the cases, 155 had low EBL and 87 had high EBL. Most myomas were of the intramural type (n = 179). The odds of EBL > 320 mL increased by 251% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.16–5.42) for five to nine myomas and by 647% (OR, 6.47; 95% CI, 1.87–22.33) for ≥10 myomas. The odds of subserosal-type myomas decreased by 67% compared with intramural-type myomas (OR, 0.33; 95% CI, 0.14–0.80). History of abdominal surgery other than cesarean section was positively correlated with EBL. The weight of the removed myomas and a history of previous cesarean section were not correlated with the EBL. Conclusion: The number of myomas (5–9 and ≥10), maximal myoma diameter, and history of abdominal surgery other than cesarean section affect the EBL in RM.


2021 ◽  
Author(s):  
Kazunori Koyama ◽  
Toru Watanabe ◽  
Hideaki Kato ◽  
Masahiko Kawaguchi

Abstract Background Aberrant right subclavian artery (ARSA) accompanied by non-recurrent inferior laryngeal nerve (NRILN) is a rare anomaly. In cases of thoracic esophageal carcinoma associated with ARSA and NRILN, surgeons must take extra care not to injury these vessels and nerves. We believe semi-prone thoracoscopic esophagectomy to be a surgical approach that can safely deal with such an anomaly. Case presentation: A 70-year-old man complained of feelings of chest constriction. Endoscopic examination revealed an esophageal tumor and computed tomography showed an ARSA. we performed semi-prone thoracoscopic esophagectomy for case with ARSA and NRILN. We identified these anomalies during esophagectomy, and we could complete surgery without injury these vessels and nerves. The patient had an uneventful recovery and discharged 22 days after surgery. Conclusions Semi-prone thoracoscopic esophagectomy for esophageal carcinoma can be performed safely with a wide operative field, and is an excellent procedure for dissecting esophageal carcinoma in patients with ARSA and NRILN.


2021 ◽  
Vol 71 (5) ◽  
pp. 1820-23
Author(s):  
Ibrahim Baloch ◽  
Bilal Umair ◽  
Asif Asghar ◽  
Muhammad Imtiaz Khan ◽  
Muhammad Shoaib Hanif

Objective: To study the post-operative outcomes of two-lung ventilation in patients undergoing prone position thoracoscopicesophagectomy. Study Design: Prospective comparative study. Place and Duration of Study: Department of Thoracic Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Dec 2019. Methodology: A total of 60 patients operated for both groups of thoraco-esophagectomy in which 34 patients for TLV (two-lung ventilation) and 26 patients for One-lung ventilation were studied. Patients position was prone for Two-lung ventilation in Thoracoscopic-esophagectomy. Post-op blood loss, Hospital stay, duration of anesthesia and operative morbidity was calculated. Results: A total of 60 patients underwent two-lung ventilation in prone position out of which patient of thoracoscopicesophagectomy were 34, while 26 underwent One-lung ventilation in semi-decubitus position thoracoscopic-esophagectomy. All of them were successfully performed without conversion to open thoracotomy. In the study with preparation span for anesthesia induction, mean time of mobilization of thoracic esophagus, mean blood loss during the thoracic mobilization phase, the mean Intensive care unit stay and total hospital stay in two-lung ventilation was less than one-lung ventilation (p<0.05). Conclusion: The present study summarized the clinical outcomes of two-lung ventilation for thoracoscopic-esophagectomy operated patients. This study data showed that Two-lung ventilation intubation in prone position is better approach during the Thoracoscopic-esophagectomy.


2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Hiroshi Sato ◽  
Yutaka Miyawaki ◽  
Naoto Fujiwara ◽  
Hirofumi Sugita ◽  
Shinichi Sakuramoto ◽  
...  

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.


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