Minimally Invasive Esophagectomy

Abstract

Minimally Invasive Surgery (MIS) for esophageal carcinoma has improved the outcome of patients. This approach has been shown to decrease the rate of respiratory complications, the intensive care unit (ICU) stay, and to allow a faster recovery of patients. Also, an improvement in perioperative care has contributed to beter outcomes compared to the open approach. MIS has been shown to be as safe as open surgery in terms of resectability, harvested lymph nodes, and overall survival.

Minimal access surgery of corrosive and thermal strictures of the foregut

“…Thoracoscopic oesophagectomy (TE) is conventionally performed in the left lateral decubitus position, using 3-5 ports. [ 11 , 13 , 14 , 21 , 29 , 36 , 51 , 58 ] Surgeon and assistant (s) stand to the patients’ right and left, respectively, while the monitor is placed cranially on the left. Ports (10/5 mm) for camera and lung retractor are placed anterior to mid-axillary line, in the 7/8 th intercostal space (ICS) and 5 th ICS, respectively.…”

“…Patients’ right arm is elevated above the head, in both positions, to move the scapula away for placing working ports. [ 11 , 58 ] Usually, a 10/12 mm camera port is placed anterior to mid-axillary line in 5-7 th ICS and two to three working ports are placed posteriorly, under vision, triangulated towards the oesophagus. [ 25 , 28 , 37 , 40 , 58 ] Cuffed ports prevent subcutaneous emphysema and repeated slippage during manipulation.…”

“…[ 11 , 58 ] Usually, a 10/12 mm camera port is placed anterior to mid-axillary line in 5-7 th ICS and two to three working ports are placed posteriorly, under vision, triangulated towards the oesophagus. [ 25 , 28 , 37 , 40 , 58 ] Cuffed ports prevent subcutaneous emphysema and repeated slippage during manipulation. Correct placement of rolls and paddings is mandatory to prevent respiratory embarrassment, abdominal compartment and skeletal/nerve injuries, as oesophagectomy takes time.…”

“…Correct placement of rolls and paddings is mandatory to prevent respiratory embarrassment, abdominal compartment and skeletal/nerve injuries, as oesophagectomy takes time. [ 37 , 58 , 59 ]…”

“…While laparoscopy requires 10–15 mm Hg of air pressure, 5–8 mm Hg suffices for thoracoscopy as collapsible lung under a rigid ribcage provides ample space. [ 12 , 15 , 20 , 25 , 28 , 31 , 58 ] A 30° telescope proves ideal both for thoracoscopy and laparoscopy. [ 31 , 32 , 58 ] Ligasure and Enseal are favored vessel sealers whereas harmonic scalpel is preferred for dissection.…”