Reconstructive esophageal surgery in fast track epoch

Shestakov, A. L.; Tarasova, I.A.; Tskhovrebov, A. T.; Boeva, I.A.; Bitarov, T T; Безалтынных, А. А.; Shakhbanov, M. E.; Dergunova, A P; Vasilieva, Ekaterina S.

doi:10.17116/hirurgia202106273

Cited by 7 publications

(1 citation statement)

References 28 publications

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“…Особенностью представленного клинического случая является то, что ключевой этап операции -это внутригрудной двухрядный ручной шов при формировании эзофагогастроанастомоза. Мы проанализировали публикации в поисковой системе по биомедицинским исследованиям PubMed, представленные метаанализы [11][12][13][14][15][16][17], а также отдельные статьи [18][19][20][21][22], в которых сравнивались эзофагогастроанастомозы с ручным и механическим швами, в ряд статей был включен опыт робот-ассистированных операций [13,16,17,23]. Авторы данных исследований сделали следующие заключения: 1) выполненные анастомозы в равных условиях, в ручном и механическом вариантах, являются одинаково состоятельными в раннем и позднем послеоперационных периодах; 2) анастомозы, выполненные ручным швом, меньше приводят к рубцовым изменениям [12,15]; 3) при формировании анастомоза с ручным швом время операции удлиняется на 60-240 минут [16]; 4) наложение ручного анастомоза при помощи роботической системы оправдано и надежно в том случае, когда хирург владеет данным навыком.…”

Section: оригинальные исследованияunclassified

First Robot-Assisted Ivor Lewis Operation with Manual Intrapleural Anastomosis for Corrosive Esophageal Stricture

Avzaletdinov,

Pavlov,

Vildanov

et al. 2023

Kreativnaâ hirurgiâ i onkologiâ

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Introduction. Esophageal pathology constitutes a small share in general morbidity, however, it remains highly relevant due to its social and clinical significance. Corrosive strictures account for a large proportion among benign esophageal diseases. Treatment of the disease starts with intraluminal surgery. However, it provides only short-term effect due to the tendency of esophageal strictures to restenosis. In case of treatment failure, esophagoplasty is performed. The esophagoplasty according to Ivor Lewis with the formation of manual intrapleural anastomosis was performed in the BSMU Clinic. The abdominal and thoracic phases were performed using Da Vinci Si robotic surgical system. By the time of publication of this paper, the authors have gained experience of 15 successfully performed surgeries of this kind.Materials and methods. The paper presents a clinical case of robot-assisted esophagoplasty according to Ivor Lewis performed on patient Y., born in 1978, with the clinical diagnosis: corrosive strictures of the lower third of the esophagus with dysphagia of III–IV degree. The pathology developed as a result of surrogate alcohol consumption in September 2017. Since October 2017, the patient has been regularly treated in the Thoracic Surgery Unit of the BSMU Clinic, where she underwent a number of endoscopic surgeries, which appeared to provide a little effect. The patient underwent a subsequent surgical treatment including esophagoplasty according to Ivor Lewis with the formation of manual intrapleural anastomosis using Da Vinci Si robotic system.Results and discussion. First three days of the postoperative period, the patient remained in the Anaesthesiology and Intensive Care Unit. She received step-by-step parenteral and enteral nutrition. Control fl uoroscopic examinations revealed timely, disturbances-free evacuation and no contrast leakage from the formed anastomosis. The patient was discharged on day 11 in satisfactory condition.Conclusion. Using Da Vinci robot-assisted system in Lewis esophageal plastic surgery has a number of specific features. It provides more precise tissue extraction with preservation of stomach and esophageal vessels, moreover, mobility of the instruments enables the key phase to be performed, namely — manual suturing in the esophagoanastomosis. As a result, the risk of postoperative complications is reduced.

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