scholarly journals Repair of tracheoesophageal fistula with pedicled sternocleidomastoid muscle flap after minimally invasive esophagectomy: A case report

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Yixing Li ◽  
◽  
Kun Fan ◽  
Jizhao Wang ◽  
Hongyi Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Tracheoesophageal Fistula ◽  
Rare Complication ◽  
Minimally Invasive Esophagectomy ◽  
Clinical Manifestations ◽  
Muscle Flap ◽  
Sternocleidomastoid Muscle ◽  
Invasive Esophagectomy ◽  
Surgical Methods ◽  
Sternocleidomastoid Muscle Flap

Background: Tracheoesophageal Fistula (TEF) is a rare complication after Minimally Invasive Esophagectomy (MIE). Various surgical methods are available for repairing TEF. In this report, we have shown the importance and feasibility of pedicled Sternocleidomastoid Muscle (SCMM) flap in dealing with TEF. Methods and results: A 57-year-old woman with esophageal squamous cell carcinoma underwent MIE in our hospital. TEF was diagnosed based on some clinical manifestations, like coughing after swallowing, a month after MIE. During the repair operation, we have utilized pedicled SCMM flap to cover the fistula after suturing the esophagus and trachea separately. No major complications occurred after the operation, and the prognosis was good. Conclusions: Pedicled sternocleidomastoid muscle flap was convenient, reliable and efficient in covering the fistula, therefore, we recommend it as the routine surgical method. However, randomized controlled trials are further needed to confirm this recommendation. TEF can be reconstructed with a pedicled SCMM flap. This method can effectively avoid further complications. Keywords: minimally invasive esophagectomy; esophageal cancer; tracheoesophageal fistula; sternocleidomastoid muscle.

270 LYMPHADENECTOMY ALONG BILATERAL RECURRENT LARYNGEAL NERVE UNDER SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
X Wu ◽  
X Gan ◽  
Q Cao
Keyword(s):  
Minimally Invasive ◽  
Recurrent Laryngeal Nerve ◽  
Minimally Invasive Esophagectomy ◽  
Cell Cancer ◽  
Laryngeal Nerve ◽  
Lower Edge ◽  
Invasive Esophagectomy ◽  
Surgical Methods ◽  
Left Neck ◽  
The Right

Abstract   Mediastinal lymphadenectomy is a crucial part of minimally invasive esophagectomy, and requires transthoracic operation, which is a crucial independent risk factor for the incidence of pulmonary complications. Conventionally, non-transthoracic esophagectomy was often achieved by mediastinoscope-assisted laparoscopic transhiatal surgery. Because of the small space, the lymphadenectomy could be only performed partially under mediastinoscope in upper mediastinal. We propose a new approach of lymphadenectomy along bilateral recurrent laryngeal nerve under mediastinoscopy through one left-neck incision. Methods A 3-cm incision paralleling the clavicle was made at 2-cm from the supraclavicular region in the left neck. After established pneumomediastinum (10-12 mmHg carbon dioxide), esophagectomy begins to perform over the aortic arch to the level of lower edge of the left main bronchus, and the lymphadenectomy along the left RLN has also accomplished during this process. At the level of lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, the instruments could get accessed to the right RLN. The lymphadenectomy could get accomplished up to 2-cm at the upper edge of the RSA. Results The mean age of 56 esophageal squamous cell cancer patients was 67.4 years, 46 males and 10 females. Tumor location: middle thoracic, 31 patients, lower thoracic, 23 patients. Preoperative TNM staging: T1b was 10 cases, T2 was 35 cases, and T3 was 11 cases. The median number of mediastinal LNs removed was 17 (9 to 23); 6 (2 to 9) along the left RLN; 3 (1 to 6) along the right RLN. 7 patients (12.5%) developed RLN palsy. Postoperative laryngoscopy showed that all of the 7 RLN palsy were left side, none of them appeared at 3 months postoperation. Conclusion This approach enables the lymphadenectomy along bilateral RLN through one left neck incision. During the operation, the upper mediastinal LNs along the bilateral RLN were clearly revealed and en bloc excised. Meanwhile, the bilateral RLN were fully exposed and protected during the procedure. Compared with the previous surgical methods,this procedure is less invasive, and the bilateral RLN could be exposed much clearer. It would provide a novel approach for the minimally invasive esophagectomy, especially lymphadenectomy.

Closure of Tracheoesophageal Fistula Using Sternocleidomastoid Muscle Flap: A Case Report

2018 ◽  
Vol 69 (1) ◽  
pp. 33-37
Author(s):  
Keiko Ohno ◽  
Yurika Kimura ◽  
Masatoki Takahashi ◽  
Koh Miwa ◽  
Motomu Honjyou ◽  
...  
Keyword(s):  
Case Report ◽  
Tracheoesophageal Fistula ◽  
Muscle Flap ◽  
Sternocleidomastoid Muscle ◽  
Sternocleidomastoid Muscle Flap

scholarly journals European consensus on essential steps of Minimally Invasive Ivor Lewis and McKeown Esophagectomy through Delphi methodology

2021 ◽  
Author(s):  
Yassin Eddahchouri ◽  
◽  
Frans van Workum ◽  
Frits J. H. van den Wildenberg ◽  
Mark I. van Berge Henegouwen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Expert Panel ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Round Table Discussion ◽  
Ivor Lewis ◽  
Delphi Methodology ◽  
Invasive Esophagectomy ◽  
European Consensus ◽  
Mckeown Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure with a long learning curve, which is associated with increased morbidity and mortality. To master MIE, training in essential steps is crucial. Yet, no consensus on essential steps of MIE is available. The aim of this study was to achieve expert consensus on essential steps in Ivor Lewis and McKeown MIE through Delphi methodology. Methods Based on expert opinion and peer-reviewed literature, essential steps were defined for Ivor Lewis (IL) and McKeown (McK) MIE. In a round table discussion, experts finalized the lists of steps 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 106 essential steps for both the IL and McK approach. Cronbach’s alpha in the first round was 0.78 (IL) and 0.78 (McK) and in the second round 0.92 (IL) and 0.88 (McK). Conclusions Consensus among European experts was achieved on essential surgical steps for both Ivor Lewis and McKeown minimally invasive esophagectomy.

Use of a sternocleidomastoid muscle flap to protect the carotid artery during laryngectomy

2021 ◽  
pp. 1-4
Author(s):  
J C Fleming ◽  
A R Fuson ◽  
H Jeyarajan ◽  
C M Thomas ◽  
B Greene
Keyword(s):  
Carotid Artery ◽  
Marked Reduction ◽  
Muscle Flap ◽  
Sternocleidomastoid Muscle ◽  
Simple Method ◽  
Initial Surgery ◽  
Great Vessels ◽  
Prevertebral Fascia ◽  
Sternocleidomastoid Muscle Flap ◽  
Salvage Laryngectomy

Abstract Objectives This paper describes a simple method of securing tissue coverage of the great vessels at the initial surgery by rotating the divided sternal heads of the sternocleidomastoid muscle, a routine step during laryngectomy, and approximating them to the prevertebral fascia. The paper presents an illustrated case example where this technique in a salvage laryngectomy repair resulted in a protected vascular axis following a salivary leak. Results Since utilising this technique, there has been a marked reduction in the requirement of subsequent flap procedures to protect vessels, and no episodes of threatened or actual carotid blowout.

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