Middle and lower esophagectomy preceded by hand-assisted laparoscopic transhiatal approach for distal esophageal cancer

Abstract

Abstract. Respiratory morbidity is the most frequent complication following an esophagectomy. This study was designed to determine the efficacy of middle and lower esophagectomies preceded by the hand-assisted laparoscopic transhiatal approach (LTHA) regarding the perioperative outcomes of distal esophageal cancer. The esophageal hiatus was opened and carbon dioxide was introduced into the mediastinum. Dissection of the distal esophagus was performed up to the level of the tracheal bifurcation. En bloc dissection of the posterior mediastinal lymph nodes was performed using the LTHA. Subsequently, a small thoracotomy (10 cm) was performed to divide the thoracic esophagus and allow middle mediastinal lymphadenectomy. Finally, reconstruction via the posterior mediastinal route with a gastric tube and anastomosis in the thoracic cavity were performed using a circular stapler. The treatment outcomes of 10 patients who underwent LTHA-preceded middle and lower esophagectomy were compared to those of 11 patients treated without prior LTHA (thoracotomy, 20 cm). The total operative time, the duration of one-lung ventilation and total operative blood loss were significantly decreased in the LTHA group. The number of resected lymph nodes did not differ significantly between the two groups. Postoperative respiratory complications occurred in 10.0% of patients treated with, and 36.3% of those treated without LTHA. The extubation time following surgery, the duration of thoracic drainage and postoperative hospital stay were significantly decreased by this method. In conclusion, middle and lower esophagectomies preceded by LTHA provides a good surgical view of the posterior mediastinum, markedly shortens the duration of one-lung ventilation and improves the perioperative outcome. IntroductionEsophagectomies is associated with significant morbidity and mortality, although recent advances in surgical and postoperative management techniques have improved the treatment outcome (1). Respiratory morbidity, in particular, remains the most common serious complication following esophagectomy and a number of studies demonstrated a respiratory complication rate of ~20% (2-5). Since the duration of one-lung ventilation is known to affect postoperative immune reactions and cause respiratory complications, it is crucial to reduce the intrathoracic operative time (6,7).We first performed an esophagectomy preceded by the laparoscopic transhiatal approach (LTHA) for patients with esophageal cancer in 2009 (8-10). With this method, carbon dioxide is introduced into the mediastinum from the abdominal side of the diaphragm and middle and lower mediastinal operations may be performed via a transhiatal approach. The main advantages of this method are that the thoracic procedures performed via right thoracotomy may be simplified and the duration of one-lung ventilation may be shortened. In addition, a good surgical view of the lower mediastinum is obtained and the quality of the mediastinal surgery may be improved. By December, 2012, a total of 121 pa...

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Short- and Long-term Progress of Recurrent Laryngeal Nerve Paralysis After Subtotal Esophagectomy

“…Some studies reported about the usefulness of intraoperative recurrent laryngeal nerve monitoring to prevent PRNP (23,24). Recently, our group have established a new surgical technique, laparoscopic transhiatal esophagectomy without thoracoscopic procedure, to achieve less invasiveness (25)(26)(27) and reported a lower incidence of PRNP in patients with laparoscopic transhiatal esophagectomy (28). Further studies with a larger number of patients appear essential to emphasize this conclusion.…”

Laparoscopic transhiatal surgery for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus: a case report

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