Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 11/2008

01-11-2008

Thoracoscopic esophageal mobilization during minimally invasive esophagectomy: a head-to-head comparison of prone versus decubitus positions

Authors: Thomas Fabian, Jeremiah Martin, Mario Katigbak, Alicia A. McKelvey, John A. Federico

Published in: Surgical Endoscopy | Issue 11/2008

Login to get access

Abstract

Background

Minimally invasive esophagectomy (MIE) is being performed at an increasing number of institutions. The thoracoscopic portion is generally performed in the left lateral decubitus position. Recently there has been increasing interest in esophageal mobilization in the prone position and the potential benefits of this technique with regard to operative time, surgeon ergonomics, and operative exposure. We sought to objectively compare thoracoscopic mobilization of the esophagus in the left lateral decubitus position versus the prone position and identify potential differences between the two techniques.

Methods

A retrospective review of a prospectively maintained esophagectomy database identified 44 patients undergoing MIE during a 20-month period (June 2005–February 2007). Of these, 32 patients underwent thoracoscopic esophageal mobilization with cervical esophagogastric anastomosis. Eleven cases were performed in the left lateral decubitus position and 21 performed in the prone position.

Results

The patients were comparable in age, tumor stage, and fraction undergoing neoadjuvant therapy. There was no statistically significant difference between decubitus position and prone position with regard to number of lymph nodes procured (14.6 versus 15.5, p = 0.69), complications (6/11 versus 10/21, p = 1.0), length of stay (9 versus 10 days, p  = 1.0), or intraoperative blood loss (85 versus 65 cc, p = 0.14). Thoracoscopic operative times were significantly shorter in the prone group than the decubitus group (86 versus 123 min, p = 0.0001).

Conclusions

Prone thoracoscopic esophageal mobilization appears to be equivalent to decubitus thoracoscopic esophageal mobilization with respect to blood loss, number of lymph nodes dissected, and complications, but with a significant reduction in thoracoscopic surgical time.
Literature
1.
Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR et al (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238(4):486–94; discussion 94–95PubMed
2.
Nguyen NT, Roberts P, Follette DM, Rivers R, Wolfe BM (2003) Thoracoscopic and laparoscopic esophagectomy for benign and malignant disease: lessons learned from 46 consecutive procedures. J Am Coll Surg 197(6):902–913PubMedCrossRef
3.
Cuschieri A (1994) Thoracoscopic subtotal oesophagectomy. Endosc Surg Allied Technol 2(1):21–25PubMed
4.
Palanivelu C, Prakash A, Senthilkumar R, Senthilnathan P, Parthasarathi R, Rajan PS et al (2006) Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position–experience of 130 patients. J Am Coll Surg 203(1):7–16PubMedCrossRef
5.
Fabian T, McKelvey AA, Kent MS, Federico JA (2007) Prone thoracoscopic esophageal mobilization for minimally invasive esophagectomy. Surg Endosc 21(9):1667–1670
6.
Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137PubMedCrossRef
7.
DePaula AL, Hashiba K, Ferreira EA, de Paula RA, Grecco E (1995) Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc 5(1):1–5PubMed
8.
Johnstone PA, Rohde DC, Swartz SE, Fetter JE, Wexner SD (1996) Port site recurrences after laparoscopic and thoracoscopic procedures in malignancy. J Clin Oncol 14(6):1950–1956PubMed
9.
Gu Y, Swisher SG, Ajani JA, Correa AM, Hofstetter WL, Liao Z et al (2006) The number of lymph nodes with metastasis predicts survival in patients with esophageal or esophagogastric junction adenocarcinoma who receive preoperative chemoradiation. Cancer 106(5):1017–1025PubMedCrossRef
10.
Jobe BA, Kim CY, Minjarez RC, O’Rourke R, Chang EY, Hunter JG (2006) Simplifying minimally invasive transhiatal esophagectomy with the inversion approach: lessons learned from the first 20 cases. Arch Surg 141(9):857–866PubMedCrossRef
11.
Nguyen NT, Follette DM, Wolfe BM, Schneider PD, Roberts P, Goodnight JE Jr (2000) Comparison of minimally invasive esophagectomy with transthoracic and transhiatal esophagectomy. Arch Surg 135(8):920–925PubMedCrossRef
12.
Orringer MB, Marshall B, Iannettoni MD (2001) Transhiatal esophagectomy for treatment of benign and malignant esophageal disease. World J Surg 25(2):196–203PubMedCrossRef
Metadata
Title
Thoracoscopic esophageal mobilization during minimally invasive esophagectomy: a head-to-head comparison of prone versus decubitus positions
Authors
Thomas Fabian
Jeremiah Martin
Mario Katigbak
Alicia A. McKelvey
John A. Federico
Publication date
01-11-2008
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 11/2008
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-008-9799-x

Other articles of this Issue 11/2008

Surgical Endoscopy 11/2008 Go to the issue

OriginalPaper

Effect of reduced stereoscopic camera separation on ring placement with a surgical telerobot

OriginalPaper

The use of fibrin sealant to prevent major complications following laparoscopic gastric bypass: results of a multicenter, randomized trial

OriginalPaper

Long-term outcome and quality of life after open and thoracoscopic thymectomy for myasthenia gravis: analysis of 131 patients

OriginalPaper

A single training center’s experience with 200 consecutive cases of diverticulitis: Can all patients be approached laparoscopically?

OriginalPaper

Accuracy of endorectal ultrasonography in staging locally advanced rectal cancer after preoperative chemoradiation

OriginalPaper

Mechanical versus suture fixation of the port in adjustable gastric banding procedures: a prospective randomized blinded study