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

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 1/2013

01-01-2013

Thoracoscopic esophagectomy while in a prone position for esophageal cancer: a preceding anterior approach method

Authors: Soji Ozawa, Eisuke Ito, Akihito Kazuno, Osamu Chino, Minoru Nakui, Soichiro Yamamoto, Hideo Shimada, Hiroyasu Makuuchi

Published in: Surgical Endoscopy | Issue 1/2013

Login to get access

Abstract

Background

In 2009, the rate of thoracoscopic esophagectomy for esophageal cancer was about 20 % in Japan. This low rate may be due to the difficulty in maintaining a good surgical field and the meticulous procedures that are required. The purpose of this study was to establish and evaluate a new procedure for performing a thoracoscopic esophagectomy while the patient is in a prone position using a preceding anterior approach to make the esophagectomy easier to perform.

Methods

We have performed thoracoscopic esophagectomy using our new procedure in 60 patients with esophageal cancer. Each patient was placed in a prone position and five trocars were inserted; only the left lung was ventilated and a pneumothorax was maintained. The esophagus was mobilized from the anterior structure during the first step and from the posterior structure during the second step. The lymph nodes around the esophagus were also dissected anteriorly and posteriorly. The patients were sequentially divided into two groups and their clinical outcomes were evaluated.

Results

The mean operative time for the thoracoscopic procedure for the latter 30 cases (203 min) was shorter than that for the former 30 cases (260 min) (P = 0.001). Among the 52 cases without pleural adhesion, the mean blood loss in the latter 26 cases (18 mL) was also less than that in the former 26 cases (40 mL) (P = 0.027). There were no conversions to a thoracotomy and no operative deaths in this series. Postoperative complications related to the thoracoscopic procedure occurred in 8 cases (27 %) in the former group and in 4 cases (13 %) in the latter group.

Conclusions

Thoracoscopic esophagectomy with the patient in the prone position using a preceding anterior approach is a safe and feasible procedure. As experience performing the procedure increases, the performance of the procedure stabilizes. This method seems to make the esophagectomy easier to perform.
Literature
1.
Cuschieri A, Shimi S, Banting S (1992) Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg 37:7–11
2.
McAnena OJ, Rogers J, Williams NS (1994) Right thoracoscopically assisted oesophagectomy for cancer. Br J Surg 81:236–238CrossRefPubMed
3.
Gossot D, Cattan P, Fritsch S, Halimi B, Sarfati E, Celerier M (1995) Can the morbidity of esophagectomy be reduced by the thoracoscopic approach? Surg Endosc 9:1113–1115CrossRefPubMed
4.
Robertson GS, Lloyd DM, Wicks AC, Veitch PS (1996) No obvious advantages for thoracoscopic two-stage oesophagectomy. Br J Surg 83:675–678CrossRefPubMed
5.
Akaishi T, Kaneda I, Higuchi N, Kuriya Y, Kuramoto J, Toyoda T, Wakabayashi A (1996) Thoracoscopic en bloc total esophagectomy with radical mediastinal lymphadenectomy. J Thorac Cardiovasc Surg 112:1533–1540 discussion 1540–1541CrossRefPubMed
6.
Law S, Fok M, Chu KM, Wong J (1997) Thoracoscopic esophagectomy for esophageal cancer. Surgery 122:8–14CrossRefPubMed
7.
Peracchia A, Rosati R, Fumagalli U, Bona S, Chella B (1997) Thoracoscopic esophagectomy: are there benefits? Semin Surg Oncol 13:259–262CrossRefPubMed
8.
Kawahara K, Maekawa T, Okabayashi K, Hideshima T, Shiraishi T, Yoshinaga Y, Shirakusa T (1999) Video-assisted thoracoscopic esophagectomy for esophageal cancer. Surg Endosc 13:218–223CrossRefPubMed
9.
Osugi H, Takemura M, Higashino M, Takada N, Lee S, Kinoshita H (2003) A comparison of video-assisted thoracoscopic oesophagectomy and radical lymph node dissection for squamous cell cancer of the oesophagus with open operation. Br J Surg 90:108–113CrossRefPubMed
10.
Committee for Scientific Affairs, Sakata R, Fujii Y, Kuwano H (2011) Thoracic and cardiovascular surgery in Japan during 2009: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg 59:636–667CrossRefPubMed
11.
Palanivelu C, Prakash A, Senthilkumar R, Senthilnathan P, Parthasarathi R, Rajan PS, Venkatachlam S (2006) Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position—experience of 130 patients. J Am Coll Surg 203:7–16CrossRefPubMed
12.
Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumours (UICC international union against cancer), 7th edn. Wiley-Blackwell, Oxford
13.
Japan Esophageal Society (2008) Japanese classification of esophageal cancer, 10th edn. Kanehara & Co, Tokyo
14.
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMed
15.
Fabian T, Martin J, Katigbak M, McKelvey AA, Federico JA (2008) Thoracoscopic esophageal mobilization during minimally invasive esophagectomy: a head-to-head comparison of prone versus decubitus positions. Surg Endosc 22:2485–2491CrossRefPubMed
16.
Noshiro H, Iwasaki H, Kobayashi K, Uchiyama A, Miyasaka Y, Masatsugu T, Koike K, Miyazaki K (2010) Lymphadenectomy along the left recurrent laryngeal nerve by a minimally invasive esophagectomy in the prone position for thoracic esophageal cancer. Surg Endosc 24:2965–2973CrossRefPubMed
17.
Ozawa S, Tachimori Y, Baba H, Fujishiro M, Matsubara H, Numasaki H, Oyama T, Shinoda M, Takeuchi H, Tanaka O, Teshima T, Udagawa H, Uno T, Barron JP (2011) Comprehensive registry of esophageal cancer in Japan, 2003. Esophagus 8:9–29CrossRef
18.
Smithers BM, Gotley DC, McEwan D, Martin I, Bessell J, Doyle L (2001) Thoracoscopic mobilization of the esophagus. A 6 year experience. Surg Endosc 15:176–182CrossRefPubMed
Metadata
Title
Thoracoscopic esophagectomy while in a prone position for esophageal cancer: a preceding anterior approach method
Authors
Soji Ozawa
Eisuke Ito
Akihito Kazuno
Osamu Chino
Minoru Nakui
Soichiro Yamamoto
Hideo Shimada
Hiroyasu Makuuchi
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 1/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-012-2404-3

Other articles of this Issue 1/2013

Surgical Endoscopy 1/2013 Go to the issue

Dynamic Manuscript

Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations

OriginalPaper

Impact of an enhanced recovery program on short-term outcomes after scheduled laparoscopic colon resection

OriginalPaper

Outcome of laparoscopic colectomy for cancer in elderly patients

OriginalPaper

Loop ileostomy closure after laparoscopic versus open surgery: is there a difference?

OriginalPaper

Factors affecting the treatment of multiple colorectal adenomas

OriginalPaper

Outcomes of simultaneous laparoscopic cholecystectomy and ventral hernia repair compared to that of laparoscopic cholecystectomy alone