Thoracoscopic Esophagectomy in Prone Versus Decubitus Position: Ergonomic Evaluation From a Randomized and Controlled Study

Background. The prone position (PP) and decubitus position (DP) have both been used for thoracoscopic esophagectomy. However, which of these positions is ergonomically better for the operating surgeon is unknown. In this randomized controlled trial (NCT01144325), we aimed to assess the surgeon's physical and mental stress in operating on patients in the PP compared with that in the DP. Methods. From October 2012 to June 2013, 67 consecutive patients who underwent a three-stage minimally invasive esophagectomy were randomly assigned to the DP or the PP during the thoracic stage. The same senior surgeon performed all operations. Objectively, the surgeon's spontaneous eye blink rate was recorded during thoracoscopic esophagectomy. Subjectively, the physician's musculoskeletal symptoms were rated on a scale ranging from 1 (uninfluenced) to 10 (maximum fatigue). Clinical characteristics, including patient demographics and operative features of the two patient groups, were statistically compared. Results. There were 35 patients in the PP group and 32 in the DP group. The two groups were comparable in patient demographics. The thoracic stage of the operation was longer in the DP group than in the PP group (87 +/- 24 minutes vs 68 +/- 22 minutes, p < 0.001), and the volume of blood loss was higher (89 +/- 18 mL vs 67 +/- 16 mL, p < 0.001). The surgeon's eye blink rate at the end of thoracic stage decreased more from baseline in the DP group than in the PP group (3.0 +/- 1.4 blinks/min vs 1.2 +/- 0.9 blinks/min, p < 0.001), and the surgeon's symptom scale score was higher after operation with the patient in the DP than in the PP (6.29 +/- 1.54 vs 3.13 +/- 2.82, p < 0.001). No conversion to open thoracotomy was recorded in either group. Conclusions. Thoracoscopic esophagectomy in the PP provided less workload and better ergonomic results than the DP. Further study based on a larger number of patients is required to confirm these findings. (C) 2014 by The Society of Thoracic Surgeons