Preemptive Endoluminal Negative Pressure in Minimally Invasive Transthoracic Esophagectomy

2019 ◽  
Author(s):  
Keyword(s):  
Minimally Invasive ◽  
Negative Pressure ◽  
Transthoracic Esophagectomy

scholarly journals Thoracic duct identification with indocyanine green fluorescence during minimally invasive esophagectomy with patient in prone position

2020 ◽  
Vol 33 (12) ◽  
Author(s):  
Massimo Vecchiato ◽  
Antonio Martino ◽  
Massimo Sponza ◽  
Alessandro Uzzau ◽  
Antonio Ziccarelli ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Prone Position ◽  
Thoracic Duct ◽  
Minimally Invasive Esophagectomy ◽  
Standard Procedure ◽  
Transthoracic Esophagectomy ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Invasive Esophagectomy

Abstract Chylothorax is a serious complication of transthoracic esophagectomy. Intraoperative thoracic duct (TD) identification represents a possible tool for preventing or repairing its lesions, and it is most of the time difficult, even during high-definition thoracoscopy. The aim of the study is to demonstrate the feasibility of using near-infrared fluorescence-guided thoracoscopy to identify TD anatomy and check its intraoperative lesions during minimally invasive esophagectomy. A 0.5 mg/kg solution of indocyanine green (ICG) was injected percutaneously in the inguinal nodes of 19 patients undergoing minimally invasive esophagectomy in a prone position, before thoracoscopy. TD anatomy and potential intraoperative lesions were checked with the KARL STORZ OPAL1® Technology. In all of the 19 patients where transthoracic esophagectomy was feasible, the TD was clearly identified after a mean of 52.7 minutes from injection time. The TD was cut for oncological radicality in two patients, and it was successfully ligated under the ICG guide. No postoperative chylothorax or adverse reactions from the ICG injection occurred. The TD identification with indocyanine green fluorescence during minimally invasive esophagectomy is a simple, effective, and non-time-demanding tool; it may become a standard procedure to prevent postoperative chylothorax.

O187 ANASTOMOTIC TECHNIQUES AND ASSOCIATED MORBIDITY IN TOTAL MINIMALLY-INVASIVE TRANSTHORACIC ESOPHAGECTOMY – RESULTS FROM THE ESOBENCHMARK DATABASE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
W Schroeder ◽  
D Raptis ◽  
H Schmidt ◽  
S Gisbertz ◽  
J Moons ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Surgical Complication ◽  
Multivariable Analysis ◽  
Current Status ◽  
Transthoracic Esophagectomy ◽  
Purse String ◽  
Comprehensive Complication Index ◽  
Double Stapling ◽  
Anastomotic Techniques

Abstract Background Total minimally-invasive transthoracic esophagectomy (ttMIE) faces increasing application in surgical treatment of esophageal cancer. For esophago-gastric reconstruction, different anastomotic techniques are currently used, but their impact on postoperative anastomotic leakage and morbidity has not been investigated. The aim of this retrospective multicenter analysis was to describe anastomotic techniques used for ttMIE and to analyze the associated morbidity. Patients and Methods Patients were selected from a basic dataset, collected over a 5-year period from 13 international surgical high-volume centers. Endpoints were anastomotic leakage rate and postoperative morbidity in correlation to anastomotic techniques, measured by the CD classification and the Comprehensive Complication Index® (CCI). Results Five anastomotic techniques were identified in 966 patients after ttMIE: Intrathoracic end-to-side circular-stapled technique in 427 patients (double-stapling n=90, purse-string n=337), intrathoracic (n=109) or cervical (n=255) side-to-side linear-stapled, and cervical end-to-side hand-sewn (n=175). Leakage rates were similar in intrathoracic and cervical anastomoses (15.9% vs. 17.2%, P=0.601), but overall complications (56.7%% vs. 63.7%, P=0.029) and median 90-day CCI (21 (IQR 0-36) vs. 29 (IQR 0-40), P=0.019) favored intrathoracic reconstructions. Leakage rates after intrathoracic end-to-side double-stapling (23.3%) and cervical end-to-side hand-sewn (25.1%) techniques were significantly higher compared with intrathoracic side-to-side linear (15.6%), end-to-side purse-string (13.9%) and cervical side-to-side linear-stapled esophago-gastrostomies (11.8%) (P<0.001). Multivariable analysis confirmed anastomotic technique as independent predictor of leakage after ttMIE. Conclusion Results of this analysis present the current status of the technical evolution of ttMIE with anastomotic leakage as predominant surgical complication. However, technique-related morbidity requires cautious interpretation considering the long learning curve of this complex surgical procedure.

An Early Experience Using the Technique of Transoral OrVil EEA Stapler for Minimally Invasive Transthoracic Esophagectomy

2011 ◽  
Vol 92 (5) ◽  
pp. 1862-1869 ◽  
Author(s):  
Dawn E. Jaroszewski ◽  
Dustin G. Williams ◽  
David E. Fleischer ◽  
Helen J. Ross ◽  
Yvonne Romero ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Early Experience ◽  
Transthoracic Esophagectomy ◽  
Eea Stapler

Can venous cannula design influence venous return and negative pressure with a minimally invasive extracorporeal circulation?

2019 ◽  
Vol 42 (12) ◽  
pp. 704-710 ◽  
Author(s):  
Mark J Bennett ◽  
Sian Hodgkiss ◽  
Clinton T Lloyd ◽  
Gerry Webb
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Minimally Invasive ◽  
Negative Pressure ◽  
Venous Return ◽  
Vena Cava ◽  
Target Range ◽  
Two Stage ◽  
Venous Cannula ◽  
Negative Pressures

Introduction: Recent advances to make cardiopulmonary bypass more physiological include the use of kinetic-assisted venous drainage but without a venous reservoir. Despite manipulation of intravascular volume and patient positioning, arterial flow is frequently reduced. Negative venous line pressures can be generated, which may elicit gaseous microemboli. We investigated the influence of venous cannula design on venous return and negative venous line pressures. Methods: In a single-centre, single-surgeon, prospective, randomized, double-blind trial, 48 patients undergoing isolated coronary artery, aortic valve or combined coronary artery and aortic valve surgery, with a minimally invasive circuit, were randomized to a conventional two-stage (2S) or three-stage venous cannula (3S), or to a three-stage venous cannula with additional ‘fenestrated’ ridges (F3S). Blood flow, venous line pressures and gaseous microemboli number and size were measured. Results: The pump flow achieved was the same between groups, but in each case fell below the target range of 2.2–2.4 L min–1 m–2. The three-stage cannula recorded significantly lower negative pressure than the other cannulae. The total count and volume of gaseous emboli detected with the F3S cannulae was very high in some cases, with wide heterogeneity. Discussion: The low negative pressures recorded with three-stage cannula, despite having a larger drainage orifice area, suggest that negative pressure may be more influenced by lumen diameter and vena cava collapse rather than drainage hole size. The additional fenestrations resulted in flow characteristics and negative pressures similar to the larger two-stage cannula but are associated with generation of gaseous microemboli.

A Propensity Score Matched Analysis of Open Versus Minimally Invasive Transthoracic Esophagectomy in the Netherlands

2017 ◽  
Vol 266 (5) ◽  
pp. 839-846 ◽  
Author(s):  
Maarten F. J. Seesing ◽  
Suzanne S. Gisbertz ◽  
Lucas Goense ◽  
Richard van Hillegersberg ◽  
Hidde M. Kroon ◽  
...  
Keyword(s):  
Propensity Score ◽  
The Netherlands ◽  
Minimally Invasive ◽  
Transthoracic Esophagectomy ◽  
Open Versus

PS01.229: SHORT- AND LONG-TERM OUTCOMES OF MINIMALLY INVASIVE TRANSTHORACIC ESOPHAGECTOMY FOR ELDERLY PATIENTS WITH ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 115-115
Author(s):  
Yusuke Muneoka ◽  
Yasuyuki Kawachi ◽  
Shigeto Makino ◽  
Yu Sato ◽  
Chie Kitami ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Survival Rates ◽  
The Elderly ◽  
Elderly Group ◽  
Transthoracic Esophagectomy ◽  
Long Term Outcomes ◽  
Short And Long Term

Abstract Background Recently, the number of elderly patients with esophageal cancer is increasing as the aging of population in Japan. Because of the benefit to reduce postoperative pulmonary complications, minimally invasive transthoracic esophagectomy (MIE) is being increasingly implemented in surgical treatment for esophageal cancer. However, short- and long-term outcomes of MIE in elderly patients have not been fully investigated. Methods We retrospectively reviewed the records of 86 patients with thoracic esophageal cancer who underwent MIE between January 2010 and December 2014 at Nagaoka Chuo General Hospital. We classified the patients into two groups according to their age: the elderly group (≥ 75 years old, n = 19) and the non-elderly group (< 75 years old, n = 67). We compared the short- and long-term outcomes between the two groups. Results There were no significant differences between the two groups in gender, comorbidity, the extent of lymphadenectomy, TNM status, or Stage (0/I/II/III/IVa/IVb: elderly group 1/1/9/8/0/0 vs. non-elderly group 5/12/26/21/2/1). Conversion rate to open esophagectomy is 10.5% in the elderly group and 6.0% in the non-elderly group (P = 0.610). The proportion of patients who received preoperative chemotherapy was significantly lower in the elderly group (21.1% vs. 67.2%, P < 0.01). With regard to surgical outcomes, there were no significant differences in operative time (301 vs. 343 min), the amount of blood loss (126 vs. 110 ml), or the median length of hospital stay (14 vs. 14 days) between the two groups. Overall morbidity was not significantly different between the two groups (47.4% vs. 49.3%, P = 0.885). The incidence of postoperative complications that were ≥  grade II according to the Clavien-Dindo classification was higher in the elderly group, but the difference was not statistically significant (42.1% vs. 25.4%, P = 0.156). The 5-year overall survival rates were 56.8% and 62.9% (P = 0.449), and the 5-year disease specific survival rates were 67.4% and 69.3% in the elderly and non-elderly groups (P = 0.564), respectively. Conclusion MIE in elderly patients with esophageal cancer can be safely performed and the long-term outcome was acceptable. However, there is a possibility of selection bias in this retrospective single-institutional study. Further multi-institutional prospective study is necessary to establish the evidence for clinical benefit of MIE for this disease. Disclosure All authors have declared no conflicts of interest.

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