Transcervical videoscopic esophageal dissection during two-field minimally invasive esophagectomy: early patient experience

Parker, Michael; Bowers, Steven P.; Goldberg, Richard E.; Pfluke, Jason M.; Stauffer, John; Asbun, Horacio J.; Smith, C. Daniel

doi:10.1007/s00464-011-1811-1

Cited by 25 publications

(15 citation statements)

References 22 publications

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“…Robot‐assisted transhiatal esophagectomy is reportedly feasible for transhiatal mediastinal LN dissection . Video‐assisted transcervical dissection of the upper mediastinal LNs, which are distant from the hiatus, is another example of a nontransthoracic approach …”

Section: Introductionmentioning

confidence: 99%

Short-term outcomes of robotic radical esophagectomy for esophageal cancer by a nontransthoracic approach compared with conventional transthoracic surgery

et al. 2015

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SummaryTransthoracic esophagectomy (TTE) is believed to have advantages for mediastinal lymphadenectomy in the treatment of resectable esophageal cancer despite its association with a greater incidence of pulmonary complications and postoperative mortality. Transhiatal esophagectomy is regarded as less invasive, though insufficient in terms of lymph node dissection. With the aim of achieving lymph dissection equivalent to that of TTE, we have developed a nontransthoracic esophagectomy (NTTE) procedure combining a video‐assisted cervical approach for the upper mediastinum and a robot‐assisted transhiatal approach for the middle and lower mediastinum. We prospectively studied 22 accumulated cases of NTTE and verified feasibility by analyzing perioperative and histopathological outcomes. We compared this group's short‐term outcomes with outcomes of 139 equivalent esophageal cancer cases operated on at our institution by conventional TTE (TTE group). In the NTTE group, there were no procedure‐related events and no midway conversions to the conventional surgery; the mean operation time was longer (median, 524 vs. 428 minutes); estimated blood loss did not differ significantly between the two groups (median, 385 mL vs. 490 mL); in the NTTE group, the postoperative hospital stay was shorter (median, 18 days vs. 24 days). No postoperative pneumonia occurred in the NTTE group. The frequencies of other major postoperative complications did not differ significantly, nor were there differences in the numbers of harvested mediastinal lymph nodes (median, 30 vs. 29) or in other histopathology findings. NTTE offers a new radical procedure for resection of esophageal cancer combining a cervical video‐assisted approach and a transhiatal robotic approach. Although further accumulation of surgical cases is needed to corroborate these results, NTTE promises better prevention of pulmonary complications in the management of esophageal cancer.

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Section: Introductionmentioning

confidence: 99%

Short-term outcomes of robotic radical esophagectomy for esophageal cancer by a nontransthoracic approach compared with conventional transthoracic surgery

et al. 2015

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“…In another article, the transcervical (left side only) approach with transhiatal esophagectomy using pneumomediastinum for either highrisk patients or for those with early esophageal carcinoma alone. 13 However, this method is not sufficient for upper mediastinum dissection. Ikeda and colleagues reported the same mediastinum method in which an additional transthoracic proce- dure is performed, if necessary, for further dissection, including dissection of the lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Mediastinoscopic Subaortic and Tracheobronchial Lymph Node Dissection With a New Cervico-Hiatal Crossover Approach in Thiel-Embalmed Cadavers

Tokairin

Nagai

Fujiwara

et al. 2015

International Surgery

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The use of mediastinal surgery for minimally invasive esophagectomy (MIE) has been proposed; however, this method is not performed as radical surgery because it has been thought to be impossible to perform complete upper mediastinal dissection, including the left tracheobronchial lymph nodes (106tbL). We herein describe a new method for performing complete dissection of the upper mediastinum. We developed a method for performing complete mediastinoscopic esophagectomy as radical surgery via the bilateral transcervical and transhiatal approach in 6 Thiel-embalmed human cadavers. The lower and middle mediastinal lymph nodes are dissected via the transhiatal approach. The dorsal side of the left recurrent nerve is dissected up to the aortic arch and left recurrent nerve lymph nodes (106recL) are dissected under pneumomediastinum. Next, the right recurrent nerve lymph nodes (106recR) are dissected. The cartilage of the left main bronchus is dissected and pushed downward, thereby obtaining a good view between the aortic arch and left main bronchus via the transhiatal approach. The 106tbL lymph nodes are dissected until the aortic arch is reached. Simultaneously, the lymph nodes are dissected via a right cervical incision. This method is termed the ''cross-over technique.'' We herein demonstrated that the upper mediastinal lymph nodes, including the 106tbL nodes, can be dissected using the bilateral transcervical and transhiatal

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“…Nonthoracic radical esophagectomy with both transcervical and transhiatal approaches using mediastinoscopic devices has been reported to have feasible surgical outcomes and advantages with regard to improved morbidity, especially for pulmonary complications . We clinically introduced robot‐assisted nonthoracic radical esophagectomy for esophageal cancer on the assumption that the cervical approach using articulated robotic devices would improve manipulation in the narrow mediastinal area and make it technically easier to dissect the lymph nodes in the upper and middle mediastinum than with conventional endosurgery.…”

Section: Our Experiences With Robot‐assisted Nonthoracic Radical Esopmentioning

confidence: 99%

Robotic surgery for the upper gastrointestinal tract: Current status and future perspectives

Nakauchi

Uyama

Suda

et al. 2017

Asian J Endoscop Surgery

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More than 4000 da Vinci Surgical Systems have been installed worldwide. Robotic surgery using the da Vinci Surgical System has been increasingly performed in the last decade, especially in urology and gynecology. The da Vinci Surgical System has not become standard in surgery of the upper gastrointestinal tract because of a lack of clear benefits in comparison with conventional minimally invasive surgery. We initiated robotic gastrectomy and esophagectomy for patients with upper gastrointestinal cancer in 2009, and we have demonstrated the potential advantages of the da Vinci Surgical System in reducing postoperative local complications after gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. However, robotic surgery has the disadvantages of a longer operative time and higher costs than the conventional approach. In this review article, we present the current status of robotic surgery for gastric and esophageal cancer, as well as future perspectives on this approach, based on our experience and a review of the literature.

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Transcervical videoscopic esophageal dissection during two-field minimally invasive esophagectomy: early patient experience

Abstract: The TVED approach may avoid the morbidity of transthoracic esophageal dissection by improving esophageal visualization. Complications with TVED appear to correlate with obesity and comorbidities. Although TVED appears feasible, a larger experience is required.

Cited by 25 publications

References 22 publications

Short-term outcomes of robotic radical esophagectomy for esophageal cancer by a nontransthoracic approach compared with conventional transthoracic surgery

Short-term outcomes of robotic radical esophagectomy for esophageal cancer by a nontransthoracic approach compared with conventional transthoracic surgery

Mediastinoscopic Subaortic and Tracheobronchial Lymph Node Dissection With a New Cervico-Hiatal Crossover Approach in Thiel-Embalmed Cadavers

Robotic surgery for the upper gastrointestinal tract: Current status and future perspectives

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