Die endoskopisch-mikrochirurgische Dissektion der Speiseröhre: ein Beitrag zur Reduzierung pulmonaler Komplikationen nach Oesophagusresektion?

Abstract

A new endoscopic microsurgical technique for dissection of the esophagus has been developed and tried out in animals. With this technique the esophagus is dissected and removed via a cervical approach by means of a new operating endoscope. In a randomized animal study we compared endoscopic versus blunt dissection and versus abdominothoracic resection. During endoscopic dissection we saw significantly lower bleeding and no laceration of the pleural cavity or damage to the recurrent laryngeal or to the vagus nerve. Significant changes of hemodynamics or gas exchange were observed in the blunt dissection group: increase of heart frequency, decrease of arterial pressure and decrease of paO2. In contrast these parameters did not change in the endoscopic group.

Experimental Study of Cardiorespiratory and Stress Factors in Esophageal Surgery Using Robot-Assisted Thoracoscopic or Open Thoracic Approach

“…In conclusion, in recent years there have been many reports of video-assisted dissection of the esophagus [38][39][40][41] or even esophagogastric reconstruction 42 in combination with a standard open laparotomy to complete the esophagectomy, 43,44 as well as the transhiatal dissection technique 45 in experimental settings. These initial and other current series, which also combined thoracoscopic and laparoscopic procedures, 46,47 confirmed that total laparoscopic and thoracoscopic esophagectomy could be safely executed and have provided an extensive array of experience in both minimally invasive and open esophageal surgery.…”