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

被引:47
作者
Ozawa, Soji [1 ]
Ito, Eisuke [1 ]
Kazuno, Akihito [1 ]
Chino, Osamu [1 ]
Nakui, Minoru [2 ]
Yamamoto, Soichiro [3 ]
Shimada, Hideo [4 ]
Makuuchi, Hiroyasu [1 ]
机构
[1] Tokai Univ, Sch Med, Dept Surg Gastroenterol, Isehara, Kanagawa 2591193, Japan
[2] So Tohoku Hosp, Dept Surg, Iwanuma, Miyagi, Japan
[3] Tokai Univ, Hachioji Hosp, Dept Surg, Hachioji, Tokyo, Japan
[4] Tokai Univ, Oiso Hosp, Dept Surg, Hiratsuka, Kanagawa 25912, Japan
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2013年 / 27卷 / 01期
关键词
Thoracoscopic esophagectomy; Esophageal cancer; Prone position; Anterior approach; MINIMALLY INVASIVE ESOPHAGECTOMY; MOBILIZATION;
D O I
10.1007/s00464-012-2404-3
中图分类号
R61 [外科手术学];
学科分类号
摘要
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. 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. 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. 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.
引用
收藏
页码:40 / 47
页数:8
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