Evaluation of Intraoperative Navigation-assisted Thoracoscopic Oesophagectomy Outcomes in the Patient's Semi-prone Position

Abstract

Video-assisted thoracoscopic esophagectomy for oesophageal cancer involving the thoracic region has certain advantages. However, thoracoscopic instrument manipulations performed in the narrow confines of the posterior mediastinum carry the risk of intraoperative injury to other vital structures.Purpose of the studyTo improve surgical treatment outcomes of thoracic oesophageal cancer patients using topographic anatomical navigation.Materials and methodsThe study included 23 patients with stages II-III middle and lower thoracic oesophageal cancer (TOC), according to TNM-8. All of them underwent thoracoscopic oesophagectomy in the semi-prone position. While the 1st group of patients (n=15) underwent conventional surgery, in the 2nd group of patients (n= 8), our algorithm of sequential visual navigation based on topographic and anatomical landmarks was employed.ResultsIn the 1st group,4 patients (26.7%) developed intraoperative complications. Out of these four, in 3 patients, injury of the thoracic lymphatic duct complicated with chylothorax development was diagnosed, requiring reoperations; in one patient, the surgery caused damage to the thoracic aorta. Unfortunately, two patients out of these four died.In contrast, there were no intraoperative complications or deaths in the 2nd group. In addition, the algorithm allowed the removal of 18% more lymph nodes, reduction in the incidence of postoperative pneumonia by 25%, the operation time by 25±15 minutes, and the length of stays by 3±2 days, compared with the 1st group of patients. ConclusionTopographic anatomical navigation can reduce the incidence of intra- and postoperative complications, effectively guide lymph node dissection, and shorten hospital stay.