Authors: Michael Parker Steven P Bowers Ross F Goldberg Jason M Pfluke John A Stauffer Horacio J Asbun C Daniel Smith
Publish Date: 2011/06/24
Volume: 25, Issue: 12, Pages: 3865-3869
Abstract
Transhiatal twofield esophagectomy reduces cardiopulmonary complications by avoiding thoracic access but requires blind mediastinal dissection The authors developed a minimally invasive esophagectomy MIE technique applying singleincision laparoscopy technology to better visualize the thoracic esophageal dissection This is performed using laparoscopy and simultaneous transcervical videoscopic esophageal dissection TVED Our aim is to demonstrate feasibility of twofield MIE with TVED and improve recovery in highrisk patientsWe performed a retrospective cohort study of eight patients who underwent twofield MIE with TVED over 10 months The majority were male N = 6 with mean age of 63 ± 12 years Mean body mass index BMI was 302 ± 51 kg/m2 Indications for operation were highgrade dysplasia N = 2 adenocarcinoma N = 6 with one receiving neoadjuvant chemoradiation Using the Charlson comorbidity index three patients were low risk and five were high risk TVED was performed with a modified singleincision access device across the left neck The mediastinal esophagus was dissected distally and circumferentially with simultaneous transabdominal laparoscopy for gastric conduit creation and distal esophageal dissectionMean operative time was 292 min range 194–375 min Three obese patients required temporary abdominal desufflation to avoid extrinsic mediastinal compression Mean estimated blood loss was 119 mL range 25–400 mL A median of 23 lymph nodes range 13–29 was harvested Median intensive care unit ICU stay was 1 day range 1–5 days and median overall stay was 7 days range 5–16 days The three lowrisk patients had no major complications Three of five highrisk patients had major complications including two cervical anastomotic leaks Major complications were seen in three of four obese patients BMI 30 kg/m2 There were no mortalitiesThe TVED approach may avoid the morbidity of transthoracic esophageal dissection by improving esophageal visualization Complications with TVED appear to correlate with obesity and comorbidities Although TVED appears feasible a larger experience is required
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