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Current status and future perspectives on minimally invasive esophagectomy.

Kawakubo H, Takeuchi H, Kitagawa Y - Korean J Thorac Cardiovasc Surg (2013)

Bottom Line: A recent meta-analysis revealed that minimally invasive esophagectomy reduces blood loss, respiratory complications, the total morbidity rate, and hospitalization duration.A randomized study reported that the pulmonary infection rate, pain score, intraoperative blood loss, hospitalization duration, and postoperative 6-week quality of life were significantly better with the minimally invasive procedure than with other procedures.In the future, sentinel lymph node mapping might play a significant role by obtaining individualized information to customize the surgical procedure for individual patients' specific needs.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Keio University School of Medicine, Japan.

ABSTRACT
Esophageal cancer has one of the highest malignant potentials of any type of tumor. The 3-field lymph node dissection is the standard procedure in Japan for surgically curable esophageal cancer in the middle or upper thoracic esophagus. Minimally invasive esophagectomy is being increasingly performed in many countries, and several studies report its feasibility and curability; further, the magnifying effect of the thoracoscope is another distinct advantage. However, few studies have reported that minimally invasive esophagectomy is more beneficial than open esophagectomy. A recent meta-analysis revealed that minimally invasive esophagectomy reduces blood loss, respiratory complications, the total morbidity rate, and hospitalization duration. A randomized study reported that the pulmonary infection rate, pain score, intraoperative blood loss, hospitalization duration, and postoperative 6-week quality of life were significantly better with the minimally invasive procedure than with other procedures. In the future, sentinel lymph node mapping might play a significant role by obtaining individualized information to customize the surgical procedure for individual patients' specific needs.

No MeSH data available.


Related in: MedlinePlus

Dissection of paratracheal lymph nodes. (A) Along the right recurrent laryngeal nerve. (B) Along the left recurrent laryngeal nerve.
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Figure 3: Dissection of paratracheal lymph nodes. (A) Along the right recurrent laryngeal nerve. (B) Along the left recurrent laryngeal nerve.

Mentions: The patient is positioned in the left semiprone position. This position is optimal because the left lateral decubitus and prone positions can be achieved by rotating the surgical table. First, the patient is positioned in the left lateral decubitus position. Five thoracic trocars and a small incision (4 cm) in the fifth intercostal space are introduced into the right chest (Fig. 2). After the azygos vein arch is divided using the Endo GIA Universal system, the upper thoracic esophagus is mobilized circumferentially, and the paraesophageal and paratracheal lymph nodes along the right and left recurrent laryngeal nerves are dissected (Fig. 3). The thoracic duct is always resected. The right bronchial artery is divided, and the left bronchial artery is always preserved to prevent bronchial ischemia. Subsequently, the patient's bed is rotated to the prone position, and the thoracic cavity is insufflated with 7 mmHg of carbon dioxide to maintain right lung collapse during thoracoscopy. The middle and lower esophagus is mobilized, and the middle and lower paraesophageal, transbronchial, and subcarinal nodes are dissected. The cervical esophagus is divided using the Endo GIA Universal system. The stumps of the esophagus are connected using a string to deliver a gastric conduit to the neck through the posterior mediastinal route.


Current status and future perspectives on minimally invasive esophagectomy.

Kawakubo H, Takeuchi H, Kitagawa Y - Korean J Thorac Cardiovasc Surg (2013)

Dissection of paratracheal lymph nodes. (A) Along the right recurrent laryngeal nerve. (B) Along the left recurrent laryngeal nerve.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756154&req=5

Figure 3: Dissection of paratracheal lymph nodes. (A) Along the right recurrent laryngeal nerve. (B) Along the left recurrent laryngeal nerve.
Mentions: The patient is positioned in the left semiprone position. This position is optimal because the left lateral decubitus and prone positions can be achieved by rotating the surgical table. First, the patient is positioned in the left lateral decubitus position. Five thoracic trocars and a small incision (4 cm) in the fifth intercostal space are introduced into the right chest (Fig. 2). After the azygos vein arch is divided using the Endo GIA Universal system, the upper thoracic esophagus is mobilized circumferentially, and the paraesophageal and paratracheal lymph nodes along the right and left recurrent laryngeal nerves are dissected (Fig. 3). The thoracic duct is always resected. The right bronchial artery is divided, and the left bronchial artery is always preserved to prevent bronchial ischemia. Subsequently, the patient's bed is rotated to the prone position, and the thoracic cavity is insufflated with 7 mmHg of carbon dioxide to maintain right lung collapse during thoracoscopy. The middle and lower esophagus is mobilized, and the middle and lower paraesophageal, transbronchial, and subcarinal nodes are dissected. The cervical esophagus is divided using the Endo GIA Universal system. The stumps of the esophagus are connected using a string to deliver a gastric conduit to the neck through the posterior mediastinal route.

Bottom Line: A recent meta-analysis revealed that minimally invasive esophagectomy reduces blood loss, respiratory complications, the total morbidity rate, and hospitalization duration.A randomized study reported that the pulmonary infection rate, pain score, intraoperative blood loss, hospitalization duration, and postoperative 6-week quality of life were significantly better with the minimally invasive procedure than with other procedures.In the future, sentinel lymph node mapping might play a significant role by obtaining individualized information to customize the surgical procedure for individual patients' specific needs.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Keio University School of Medicine, Japan.

ABSTRACT
Esophageal cancer has one of the highest malignant potentials of any type of tumor. The 3-field lymph node dissection is the standard procedure in Japan for surgically curable esophageal cancer in the middle or upper thoracic esophagus. Minimally invasive esophagectomy is being increasingly performed in many countries, and several studies report its feasibility and curability; further, the magnifying effect of the thoracoscope is another distinct advantage. However, few studies have reported that minimally invasive esophagectomy is more beneficial than open esophagectomy. A recent meta-analysis revealed that minimally invasive esophagectomy reduces blood loss, respiratory complications, the total morbidity rate, and hospitalization duration. A randomized study reported that the pulmonary infection rate, pain score, intraoperative blood loss, hospitalization duration, and postoperative 6-week quality of life were significantly better with the minimally invasive procedure than with other procedures. In the future, sentinel lymph node mapping might play a significant role by obtaining individualized information to customize the surgical procedure for individual patients' specific needs.

No MeSH data available.


Related in: MedlinePlus