Minimal Invasive Esophagectomy By Video Assist Transhiatal and Transcervical Approache
Jiang yuequan, M.D.
Chongqing Cancer Institute, Chongqing, China.
OBJECTIVE: We establish a video assistant transhiatal-transcervical approach (VATT) which can let the entire esophagus be dissected under video scope without tranthorax.
METHODS: Patient was in supine position. Abdomen part: Gastric was dissociated under laparoscope. Distal and middle part of the esophagus was dissected with the laparoscope. The lower mediastinal lymph nodes including subcarinal lymphnode were dissected under laparoscope. Cervical part: Two incisions in neck were made, a 3-4cm incision in left side, another 1-2cm incision in right side. From the left side incision, blunt dissection of the cervical esophagus was carried down to the level below thoracic inlet. The esophagus was cut off at the level of thoracic inlet. A traction tube was inserted into the distal esophagus. The end of traction tube was fixed to the cutting edge of distal esophagus; the top of the traction tube was taken out from a small incision made in lesser curvature of stomach. Pulling the traction tube slightly, the edge of esophagus was invaginated in the channel of esophagus; a space in the upper mediastinum was established. A trocar was placed in right side cervical incision. In the left side cervical incision, a device made by our-self was placed in. This device is consisted with a glove, a wound retractor protective sleeve and three trocars (figure 3). With this device, the mediastinum space can be insufflated with carbon dioxide gas, it let the dissection of upper esophagus and lymph nodes become easy under video scope.
RESULTS: Comparing to (Minimal invasive esophagectomy) MIE group, the dissection frequency of lymph nodes was relatively lower at stations 2R, 4R and 10 in TTA group, but the metastasis rate was similar. Moreover, both the dissection and metastasis frequency at the other stations were no difference between the TTA and MIE. Despite high incidence in recurrent laryngeal nerve palsy (single-side), The TTA was significantly superior to the MIE with a shorter surgical duration, shorter ICU/hospital stay, and lower postoperative pulmonary complications.
CONCLUSIONS: The TTA procedure of esophagectomy was effective and safe, which can be applied as one of supplementary operation methods to traditional minimally invasive esophagectomy.
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