Minimally invasive esophagectomy and radical lymph node dissection without recurrent laryngeal nerve paralysis

Otsuka, Koji; Murakami, Masahiko; Goto, Satoru; Ariyoshi, Tomotake; Yamashita, Takeshi; Saitō, Akira; Kohmoto, Masahiro; Kato, Rei; Lefor, Alan Kawarai; Aoki, Takeshi

doi:10.1007/s00464-020-07372-3

Cited by 25 publications

(13 citation statements)

References 26 publications

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“…Therefore, surgeons can accurately perform a procedure and protect the RLN, which must be preserved. Moreover, Otsuka et al showed that touching or stretching the recurrent laryngeal nerve can be a risk factor for palsy (29). Furthermore, the current study suggested that RAMIE reduced touching or stretching the recurrent laryngeal nerve compared to OE and VATS.…”

Section: Discussionsupporting

confidence: 51%

Short-term Outcomes of Robot-assisted Minimally Invasive Esophagectomy Compared With Thoracoscopic or Transthoracic Esophagectomy

et al. 2021

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Background/Aim: There is no study comparing open esophagectomy (OE), video-assisted thoracic surgery (VATS), and robot-assisted minimally invasive esophagectomy (RAMIE) in a single institution. Patients and Methods: This study included 272 patients who underwent subtotal esophagectomy divided into three groups: OE (n=110), VATS (n=127), and RAMIE (n=35) groups. Moreover, short-term outcomes were compared. Results: Overall complications (CD≥II) were significantly less in the RAMIE than the OE and VATS groups. Recurrent laryngeal nerve paralysis (CD≥II) was significantly lower in the RAMIE than the OE group (p=0.026) and tended to be lower than that in the VATS group (p=0.059). The RAMIE group had significantly less atelectasis (CD≥I and II), pleural effusion (CD≥I and II), arrhythmia (CD≥II), and dysphagia (CD≥II), than both the OE and VATS groups. Conclusion: RAMIE reduced overall postoperative complications after esophagectomy compared with both OE and VATS.Esophageal cancer is the sixth leading cause of cancerrelated mortality worldwide because of its high malignant potential and poor prognosis (1). The postoperative 5-year survival rate in patients with American Joint Committee on Cancer stage I esophageal cancer is approximately 90%. This rate decreases to 45%, 20%, and 10% in patients with stages II, III, and IV diseases, respectively (2). Esophagectomy remains the most efficient treatment option, although chemoradiotherapy may effectively treat esophageal cancer (3). Despite advances in extended lymph node (LN) dissection and perioperative management of esophagectomy, it remains a highly invasive procedure associated with serious postoperative complications (4). The Japanese national database, including 5,354 esophagectomy patients in 713 hospitals in 2011, reported an overall morbidity rate of 41.9% and a 30-day and surgery-related mortality of 1.2% and 3.4%, respectively (5).Thoracoscopic esophagectomy constitutes an attractive and less invasive alternative because esophagectomy with radical lymphadenectomy is one of the most invasive gastrointestinal surgeries (6). Of the patients, 4,209 (66.8%) underwent video-assisted thoracoscopic surgery (VATS). According to a Japanese national database, the ratio increases annually, including 6,298 esophagectomy patients in 2019 (7). Robot assistance provides an enlarged, threedimensional field of view and improves the surgeon's dexterity due to surgical wrists and tremor filtration (8). Multiple retrospective studies have investigated the surgical outcomes of robot-assisted minimally invasive esophagectomy (RAMIE) compared to VATS since its development in 2003 (9-12). A randomized controlled trial reported the benefits of RAMIE over conventional open esophagectomy (OE) in terms of short-term outcomes, and comparable long-term results to OE were found (13).However, there is no study comparing the three techniques of OE, VATS, and RAMIE in a single institution. This study hypothesized that VATS reduced postoperative complications compared to OE. Moreover, RAMIE reduc...

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Section: Discussionsupporting

confidence: 51%

Short-term Outcomes of Robot-assisted Minimally Invasive Esophagectomy Compared With Thoracoscopic or Transthoracic Esophagectomy

et al. 2021

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“…This latest advancement maintains all the previous benefits of HARMONIC HD 1000i at lower maximum blade temperatures. Multiple clinical studies have shown the effective use of the current HD 1000i Shears in various procedures including pancreatectomy [12], breast reconstruction capsulectomy [13], laparoscopic hysterectomy [14], and esophagectomy [15]. Benchtop and preclinical results in this study suggest similar performance for the HARMONIC 1100 Shears, and it is anticipated that clinical results will also be comparable.…”

Section: Discussionmentioning

confidence: 66%

Intelligent Ultrasonic Energy: New Adaptive Tissue Technology in Harmonic Shears

Singleton¹,

Juncosa-Melvin²,

Scoggins³

et al. 2020

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Objective: Development of ultrasonic technology in surgical devices includes mechanisms of monitoring and adjusting energy delivery to target tissues for the purpose of limiting thermal spread. The objective of the current study was to evaluate performance of a new Adaptive Tissue Technology algorithm, designed to enhance thermal management in the HARMONIC 1100 Shears. Methods: The HARMONIC 1100 Shears were evaluated with bench-top and in vivo preclinical (porcine) analyses for tissue thermal spread, blade heat, transection speed, hemostasis and vessel sealing performance. Testing was performed in parallel with the current production HARMONIC HD 1000i Shears to confirm non-inferiority of the new Adaptive Tissue Technology algorithm. Results: Bench top analysis revealed significantly lower average maximum blade temperatures for HARMONIC 1100 compared to HARMONIC HD 1000i as well as HARMONIC ACE+ 7 Shears with Advanced Hemostasis. Thermal spread, transection speeds, and burst pressure tests of excised porcine carotid arteries did not show a statistical difference between HARMONIC 1100 and HD 1000iShears. In vivo analysis of hemostasis following sealing/transection of various blood vessels in acute porcine testing demonstrated similar efficacy for HARMONIC 1100 and HD 1000i Shears. Likewise, tissue lateral thermal damage showed no statistical difference between the new and previous generation Harmonic device in the porcine model. Conclusion: The new Adaptive Tissue Technology in HARMONIC 1100 Shears allows for reduced maximum blade temperatures while providing effective hemostasis, sealing strength, transection speed, and limited thermal damage.

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“…46 Therefore, more and more surgeons preferred T-2FL + for thoracic ESCC without suspected SLNM. 27,44,45,47 However, 19 68/78 OE 58.0/61.0% 5.9/9.0% 2.9/0% Shim et al 20 57 16,29,34 It has been recommended that at least 15 LNs should be dissected in patients who do not receive neoadjuvant therapy in the NCCN Guidelines R , but there are no principles for which regions of the LN have to be dissected. 48 In fact, more LN dissection can provide more accurate staging and meanwhile reduce the local recurrence incidence.…”

Section: Total 2fl (T-2fl): Lymphadenectomy For Lnsmentioning

confidence: 99%

“…After the application of this technique, they reported that RLN palsy did not occur in a continuous cohort of 87 patients who underwent MIE. 27 Shirakawa et al proposed a microanatomical concept of the visceral sheath and the vascular sheath. The visceral sheath wraps the trachea, esophagus, and the so-called mesoesophagus containing RLN LNs, while the vascular sheath wraps the surrounding vessels and nerves.…”

Section: Rln Protection In Miementioning

confidence: 99%

“…24,25 However, compared with OE, whether or not the structure and function of the bilateral recurrent laryngeal nerves (RLNs) could be better preserved under a thoracoscope during MIE is still uncertain. 26,27 In summary, thus far, many disputes about lymphadenectomy for thoracic EC exist and have not been clarified. The purpose of our review is specifically to address the pat-terns of LN metastasis, the extent of LN dissection, and the protection of the RLN in MIE for thoracic ESCC.…”

Section: Introductionmentioning

confidence: 99%

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Lymph node dissection and recurrent laryngeal nerve protection in minimally invasive esophagectomy

Wang

Mao

Gao

et al. 2020

Annals of the New York Academy of Sciences

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Until now, neoadjuvant therapy plus surgical resection of the primary tumor and potential metastatic lymph nodes (LNs) has been the current optimal treatment for locally advanced thoracic esophageal cancer (EC). LN metastasis is one of the most negative prognostic factors for thoracic esophageal squamous cell carcinoma (ESCC). However, the extent of LN dissection for thoracic ESCC has long been controversial worldwide. LNs along the recurrent laryngeal nerve (RLN) were reported to have the highest frequency of metastases in thoracic ESCC, so lymphadenectomy along the bilateral RLN is necessary but quite challenging because of a high frequency of recurrent nerve palsy and related postoperative complications. With the development of minimally invasive devices and techniques in recent years, minimally invasive esophagectomy (MIE) has been widely applied in EC surgery. The topics of what the optimal extent of lymphadenectomy is and how the recurrent nerve should be well protected during MIE have been debated in recent years. The purpose of our review is specifically to address the patterns of LN metastasis, the extent of LN dissection, and the protection of the RLN in MIE for thoracic ESCC.

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Minimally invasive esophagectomy and radical lymph node dissection without recurrent laryngeal nerve paralysis

Cited by 25 publications

References 26 publications

Short-term Outcomes of Robot-assisted Minimally Invasive Esophagectomy Compared With Thoracoscopic or Transthoracic Esophagectomy

Short-term Outcomes of Robot-assisted Minimally Invasive Esophagectomy Compared With Thoracoscopic or Transthoracic Esophagectomy

Intelligent Ultrasonic Energy: New Adaptive Tissue Technology in Harmonic Shears

Lymph node dissection and recurrent laryngeal nerve protection in minimally invasive esophagectomy

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