In long-segment esophageal reconstruction with supercharged colon, although thoracoscopy is feasible, laparoscopy is found unsafe. Careful preoperative planning and colon assessment via computed tomography(CT) colonography/angiography and a multidisciplinary team approach is recommended. Adjuncts to assess conduit perfusion like the Spy system are helpful. Supercharging the long colonic conduit is a way of minimizing ischemia-related complications.

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Background Totally minimally invasive oesophagectomy although challenging to perform has garnered popularity in the surgical treatment of oesophageal cancer. Advanced laparoscopic surgical skills are needed with the construction of the intra-thoracic anastomosis in the case of a 2-stage procedure being the rate-limiting step. We aim to report our initial experience and short-term outcomes of totally minimally invasive 3-stage and 2-stage oesophagectomies for cancer. Methods From January 2016 when the minimally invasive oesophagectomy programme was implemented in our Unit, to December 2017, 65 consecutive cases underwent either a 2-stage or a 3-stage oesophagectomy for cancer. In all cases a radical 2-field lymph node dissection was performed. All were performed in a prone position and in the 3-stage oesophagectomies, superior mediastinal lympadenectomy was additionally performed. In the 2-stage cases an end-to-side esophago-gastric anastomosis was constructed in two layers with barbed knotless suture (V-LocTM). Results Male: female was 4:1 with a mean age of 66.44 years (IQR, 43–82). n = 53 were 2-stage and 12 were 3-stage oesophagectomies. Thirty five (53.8%) had neoadjuvant chemotherapy and 30(46.2%) went straight to surgery. There were no open conversions. No feeding jejunostomies were placed routinely. Complete resection (R0) rate was 61.54% (40/65) with a mean lymph node harvest of 28 (IQR, 11–68). Five (7.6%) anastomotic leaks were diagnosed (4 in 2-stage and 1 in 3-stage oesophagectomies), with 1(1.5%) of them (in the 2-stage group) being subclinical requiring no intervention. Furthermore, 1(1.5%) chyle leak and 1(1.5%) gastric staple line leak were also observed. Pulmonary complications were reported in 13.8% of cases and cardiac complications arose in 1.5%. Seven (10.8%) anastomotic strictures were also noted that were treated with endoscopic balloon dilatation. Mean hospital stay was 13 days and 30-day mortality rate was 4.62%. Conclusion Implementation of a minimally invasive oesophagectomy program in our high-volume tertiary centre is yielding good initial results. Vast previous experience in the field is of paramount importance. Hand-sewn intrathoracic anastomosis during 2-stage procedures is feasible and with repetitively good outcomes. Disclosure All authors have declared no conflicts of interest.

Aim Three-dimensional laparoscopy improves the depth of perception during minimally invasive surgery, leading to better visibility and more precise dissection, and providing better clinical and surgical outcomes in complex surgical procedures. The aim of this study was to compare the pros and cons of the 3D technological systems available in our Unit for UGI surgery. Background & Methods In our Unit, we have two different 3D systems for abdominal and thoracic surgery. B Braun has the EinsteinVision 3D system with 0 and 30 degree fixed camera. Olympus produces an Endoeye Flex with an articulating tip 0 degree 3D camera as well as an Endoeye 3D 0 and 30 degree rotating camera. Advantages and disadvantages of the different 3D systems were evaluated on the basis of the experience of our senior surgeons performing routinely 3D operations. Results All surgeons agreed of the superiority of 3D vision compared to conventional 2D laparoscopy or thoracoscopy. The B Braun system is not available in an integrated operating theatre system and does not allow image rotation, but provides a full HD sharp resolution and has the advantage of a reusable camera with single use warming cover which could be used for unlimited procedures every day. The Olympus Endoeye Flex does not provide HD resolution and can be more difficult to manoeuvre, but has the advantage of the articulating tip. The Olympus Endoeye 30 degree rotating camera has a better HD resolution and the advantage of image rotation while maintaining the horizon. Conclusion Technology beyond 3D laparoscopic system has been evolving rapidly. Different products have their own strengths and weaknesses, and surgeons should be familiar with the system used.