Transcervical videoscopic esophageal dissection in minimally invasive esophagectomy

Parker, Michael; Pfluke, Jason M.; Shaddix, Kyle K.; Asbun, Horacio J.; Smith, C. Daniel; Bowers, Steven P.

doi:10.1007/s00464-010-1253-1

Cited by 9 publications

(6 citation statements)

References 9 publications

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“…[21][22][23] We were able to apply this technique to mediastinal operations without any major problems. Although some reports about mediastinoscopeassisted esophagectomy have described the use of a mediastinoscope from the cervical side, [24][25][26] most esophageal surgeons do not get used to this surgical view, and therefore, they need to master certain skills. On the other hand, our procedure, which is performed via a transhiatal approach, can easily be performed in institutes that use HALS for abdominal esophageal surgery.…”

Section: Discussionmentioning

confidence: 99%

Perioperative outcomes of esophagectomy preceded by the laparoscopic transhiatal approach for esophageal cancer

et al. 2012

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This study was designed to determine the efficacy of esophagectomy preceded by the laparoscopic transhiatal approach (LTHA) with regard to the perioperative outcomes of esophageal cancer. The esophageal hiatus was opened by hand-assisted laparoscopic surgery, 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 LTHA. Next, cervical lymphadenectomy, reconstruction via a retrosternal route with a gastric tube and anastomosis from a cervical approach were performed. Finally, a small thoracotomy (around 10 cm in size) was made to extract the thoracic esophagus and allow upper mediastinal lymphadenectomy to be performed. The treatment outcomes of 27 esophageal cancer patients who underwent LTHA-preceding esophagectomy were compared with those of 33 patients who underwent the transthoracic approach preceding esophagectomy without LTHA (thoracotomy; around 20 cm in size). The intrathoracic operative time and operative bleeding were significantly decreased by LTHA. The total operative time did not differ between the two groups, suggesting that the abdominal procedure was longer in the LTHA group. The number of resected lymph nodes did not differ between the two groups. Postoperative respiratory complications occurred in 18.5% of patients treated with LTHA and 30.3% of those treated without it. The increase in the number of peripheral white blood cells and the duration of thoracic drainage were significantly decreased by this method. Our surgical procedure provides a good surgical view of the posterior mediastinum, markedly shortens the intrathoracic operative time, and decreases the operative bleeding without increasing major postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Perioperative outcomes of esophagectomy preceded by the laparoscopic transhiatal approach for esophageal cancer

et al. 2012

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“…In addition, during thoracoscopic esophagectomy in the prone position, it takes time to perform intrathoracic surgery [15,16]. Although some reports about mediastinoscope-assisted esophagectomy have described the use of a mediastinoscope from the cervical side [17,19,20], most esophageal surgeons are not used to this surgical view, and therefore, need to master new skills. In contrast, our method enables the surgeon to easily perform middle and lower thoracic mediastinal surgery from the abdominal side and reduces the intrathoracic operative time.…”

Section: Discussionmentioning

confidence: 98%

Posterior mediastinal lymph node dissection using the pneumomediastinum method for esophageal cancer

et al. 2012

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Although posterior mediastinal lymph node metastases are often observed in patients with esophageal cancer, their complete resection via a right thoracic approach is difficult and carries a risk of complications. We have developed a novel procedure for en-bloc dissection of the posterior mediastinal lymph nodes using the pneumomediastinum method. The patient was a 48-year-old female with middle thoracic esophageal cancer. A computed tomography scan showed a posterior mediastinal lymph node 1 cm in diameter. After division of the gastrosplenic ligament by hand-assisted laparoscopic surgery, the esophageal hiatus was opened, and carbon dioxide was introduced into the mediastinum. The anterior and left sides of the distal esophagus were separated, and a swollen posterior mediastinal lymph node was detected. Subsequently, the adventitia of the thoracic aorta was exposed, and the posterior side of the lymph node was separated. While lifting these nodes like a membrane, we cut them along the border of the left mediastinal pleura. Histopathological examination revealed a single squamous cell carcinoma metastasis in the resected lymph node. A good surgical view was obtained in our surgical procedure, and en-bloc dissection of the posterior mediastinal lymph nodes was safely performed.

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“…Based on the belief that a transhiatal and extrapleural approach to esophagectomy is less invasive than a transthoracic approach, we sought to develop an improved approach to transhiatal MIE. This led to the development of the TVED technique, which evolved after observing the ease of dissecting the esophagus from the membranous trachea with the aid of gas insufflation in a natural orifice translumenal endoscopic surgery (NOTES) animal model [11]. We developed a technique of dissecting the upper thoracic esophagus using off-the-shelf equipment designed for single-port laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Following our initial animal experience with this technique [11], we herein report our initial experience in eight patients. The aim of this work is to demonstrate the feasibility of two-field MIE using transcervical videoscopic esophageal dissection (TVED) for patients with high-grade dysplasia or early esophageal cancer, or high-risk patients with severe comorbidities.…”

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confidence: 99%

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

et al. 2011

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Transcervical videoscopic esophageal dissection in minimally invasive esophagectomy

Cited by 9 publications

References 9 publications

Perioperative outcomes of esophagectomy preceded by the laparoscopic transhiatal approach for esophageal cancer

Perioperative outcomes of esophagectomy preceded by the laparoscopic transhiatal approach for esophageal cancer

Posterior mediastinal lymph node dissection using the pneumomediastinum method for esophageal cancer

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

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