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Thoracoscopic resection for esophageal cancer: A review of literature.

Scheepers JJ, van der Peet DL, Veenhof AA, Cuesta MA - J Minim Access Surg (2007)

Bottom Line: Esophageal resection remains the only curative option in high grade dysplasia of the Barrett esophagus and non metastasized esophageal cancer.In addition, it may also be an adequate treatment in selected cases of benign disease.A wide variety of minimally invasive procedures have become available in esophageal surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Vrije Universiteit Medical Centre (VUMC), Amsterdam, Netherlands.

ABSTRACT
Esophageal resection remains the only curative option in high grade dysplasia of the Barrett esophagus and non metastasized esophageal cancer. In addition, it may also be an adequate treatment in selected cases of benign disease. A wide variety of minimally invasive procedures have become available in esophageal surgery. Aim of the present review article is to evaluate minimally invasive procedures for esophageal resection, especially the approach performed through right thoracoscopy.

No MeSH data available.


Related in: MedlinePlus

Placement of ports for right thoracoscopic stage of the procedure
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Figure 0001: Placement of ports for right thoracoscopic stage of the procedure

Mentions: The patient is intubated with a double-lumen tube to block the right lung and is positioned in the left lateral decubitus position. The surgeon stands on the right side and assistant on the left. Four or five thoracoscopic trocars are introduced between the anterior and posterior axillary lines [Figure 1]. Luketich et al., placed the 10 mm camera at the 7th to 8th intercostal space, just anterior to the midaxillary line. A 5 mm port is placed at the 8th or 9th intercostal space, posterior to the posterior axillary line for the Ultracision device (Johnson and Johnson). Another 10 mm port is placed in the anterior axillary line at the 4th intercostal space (for a fan to retract the lung) and the last 5 mm port is placed just posterior to the scapula tip (for traction and countertraction instruments)[10]. After division of the inferior pulmonary ligament and after incision of the pleura, a normal segment of the esophagus is mobilized and a Penrose drain is placed around it. The pleura are then divided up to the level of the azygos vein and the vein is divided by endovascular stapler [Figure 2]. The pleura opening continues up to 2-4 cm above the carina. The esophagus is mobilized with the fat tissue and lymph nodes around it up to the planes of aorta, pericardial sac and contralateral pleura [Figure 3]. Because it is not an en bloc resection, the azygos vein and the thoracic duct are not resected. During the division of the tissue around the esophagus, especially the vessels coming from the aorta have to be clipped in order to avoid lymph leakage. The distal part of the esophagus around the hiatus is not dissected during the thoracoscopic stage in order to avoid leakage of CO2 in the chest during the laparoscopic part of the operation.


Thoracoscopic resection for esophageal cancer: A review of literature.

Scheepers JJ, van der Peet DL, Veenhof AA, Cuesta MA - J Minim Access Surg (2007)

Placement of ports for right thoracoscopic stage of the procedure
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2749198&req=5

Figure 0001: Placement of ports for right thoracoscopic stage of the procedure
Mentions: The patient is intubated with a double-lumen tube to block the right lung and is positioned in the left lateral decubitus position. The surgeon stands on the right side and assistant on the left. Four or five thoracoscopic trocars are introduced between the anterior and posterior axillary lines [Figure 1]. Luketich et al., placed the 10 mm camera at the 7th to 8th intercostal space, just anterior to the midaxillary line. A 5 mm port is placed at the 8th or 9th intercostal space, posterior to the posterior axillary line for the Ultracision device (Johnson and Johnson). Another 10 mm port is placed in the anterior axillary line at the 4th intercostal space (for a fan to retract the lung) and the last 5 mm port is placed just posterior to the scapula tip (for traction and countertraction instruments)[10]. After division of the inferior pulmonary ligament and after incision of the pleura, a normal segment of the esophagus is mobilized and a Penrose drain is placed around it. The pleura are then divided up to the level of the azygos vein and the vein is divided by endovascular stapler [Figure 2]. The pleura opening continues up to 2-4 cm above the carina. The esophagus is mobilized with the fat tissue and lymph nodes around it up to the planes of aorta, pericardial sac and contralateral pleura [Figure 3]. Because it is not an en bloc resection, the azygos vein and the thoracic duct are not resected. During the division of the tissue around the esophagus, especially the vessels coming from the aorta have to be clipped in order to avoid lymph leakage. The distal part of the esophagus around the hiatus is not dissected during the thoracoscopic stage in order to avoid leakage of CO2 in the chest during the laparoscopic part of the operation.

Bottom Line: Esophageal resection remains the only curative option in high grade dysplasia of the Barrett esophagus and non metastasized esophageal cancer.In addition, it may also be an adequate treatment in selected cases of benign disease.A wide variety of minimally invasive procedures have become available in esophageal surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Vrije Universiteit Medical Centre (VUMC), Amsterdam, Netherlands.

ABSTRACT
Esophageal resection remains the only curative option in high grade dysplasia of the Barrett esophagus and non metastasized esophageal cancer. In addition, it may also be an adequate treatment in selected cases of benign disease. A wide variety of minimally invasive procedures have become available in esophageal surgery. Aim of the present review article is to evaluate minimally invasive procedures for esophageal resection, especially the approach performed through right thoracoscopy.

No MeSH data available.


Related in: MedlinePlus