Predictive factors of difficulty of thoracoscopic esophagectomy in the left decubitus position

Fujiwara, Yushi; Lee, Shigeru; Gyobu, Ken; Inazu, Daiki; Naka, Ryoko; Nishiyama, Mitsuru; Ohira, Masaichi; Osugi, Harushi

doi:10.1007/s10388-019-00663-2

Cited by 4 publications

(7 citation statements)

References 12 publications

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“…To the best of our knowledge, this is the first study to assess the technical difficulty of TME with a focus on transcervical SCLN dissection. Two previous studies have examined the factors influencing technical difficulty in esophagectomy [19,20]. Fujiwara et al identified the aorta-vertebra angle, sternum-vertebra distance, and clinical T stage as predictive factors for the technical difficulty of thoracoscopic esophagectomy in the left decubitus position [19].…”

Section: Discussionmentioning

confidence: 99%

“…Two previous studies have examined the factors influencing technical difficulty in esophagectomy [19,20]. Fujiwara et al identified the aorta-vertebra angle, sternum-vertebra distance, and clinical T stage as predictive factors for the technical difficulty of thoracoscopic esophagectomy in the left decubitus position [19]. Okamura et al reported that the vertebral body projection at the middle thoracic part was a useful tool for predicting the difficulty of thoracoscopic esophagectomy in the prone position [20].…”

Section: Discussionmentioning

confidence: 99%

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Predictors of the difficulty of transcervical subcarinal lymph node dissection for esophageal cancer

et al. 2023

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Background Transmediastinal radical esophagectomy (TME) is a new minimally invasive approach without thoracotomy. However, the transcervical dissection of subcarinal lymph nodes (SCLN) is challenging. The shape or narrowness of the mediastinal space, particularly around the aortic arch to the tracheal bifurcation, may increase the difficulty of this procedure. The present study aimed to clarify predictors of the difficulty of transcervical SCLN dissection. Methods Patients who underwent TME between 2016 and 2019 were included (n = 126). Four indicators, the cervical angle, carina distance, aorta distance, and sternum distance, were defined as indicators of mediastinal narrowness by 3D-CT. The relationships between the difficulty of transcervical SCLN dissection and clinicopathological features, including the above indicators, were investigated. Results In a univariate analysis, the cervical angle (p = 0.023), aorta distance (p = 0.002), and middle thoracic tumor (p = 0.040) correlated with difficulty. The median cervical angle and aorta distance were 15° and 33 mm in difficult cases and 19° and 43 mm in easy cases, respectively. In a multivariate analysis, the short aorta distance (odds ratio: 7.96, p = 0.002) and middle thoracic tumor (odds ratio: 3.35, p = 0.042) were independent predictive factors. Conclusions The cervical angle, aorta distance, and middle thoracic tumor may predict the difficulty of transcervical SCLN dissection. In difficult cases, a transhiatal approach should be combined for complete SCLN dissection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of the difficulty of transcervical subcarinal lymph node dissection for esophageal cancer

et al. 2023

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“…This is probably why there are studies in different surgical disciplines [3–5] on factors that determine technical complexity. There are even validated preoperative scores for certain surgical procedures that can reliably predict technical difficulty [6].…”

Section: Introductionmentioning

confidence: 99%

“…There are even validated preoperative scores for certain surgical procedures that can reliably predict technical difficulty [6]. Ability to accurately predict technical difficulty may further allow surgeons to choose a different patient approach likely to be technically more difficult [7] and to choose patients suitable for training [5]. It may also allow for a more reliable comparison of surgical outcomes [1] and better planning of theatre schedule as more difficult cases could be allotted more time [8].…”

Section: Introductionmentioning

confidence: 99%

“…This can potentially improve the consenting process as well as improve outcomes by the adoption of mitigating strategies. This is probably why there are studies in different surgical disciplines [3][4][5] on factors that determine technical complexity. There are even validated preoperative scores for certain surgical procedures that can reliably predict technical difficulty [6].…”

Section: Introductionmentioning

confidence: 99%

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Factors that make Bariatric Surgery Technically Challenging: A Survey of 370 Bariatric Surgeons

Shahabi

Carbajo²,

Nimeri

et al. 2021

World j. surg.

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Background There is no published data on the factors bariatric surgeons think make bariatric surgery challenging. This study aimed to identify factors that bariatric surgeons feel and increase the technical complexity of bariatric surgery. Methods Bariatric surgeons from around the world were invited to participate in a questionnaire-based survey on Survey MonkeyÒ. An Average Weighted Score was calculated for each factor. A score of \ 1.0 meant that the factor was perceived to make surgery technically easier. Results Three hundred seventy bariatric and metabolic surgeons from 59 countries completed the survey. The top 10 factors that our respondents felt were most important for determining the technical difficulty of a procedure were inappropriate trocar placement (AWS 3.44), BMI above 60 (AWS 3.41), open bariatric surgery (AWS 3.26), less experienced bariatric anesthetist (AWS 3.18), liver cirrhosis (AWS 3), large liver (AWS 2.99), less experienced bariatric assistant (AWS 2.97), lower surgeon total bariatric surgery volume (AWS 2.95), lower surgeon specific procedure volume (AWS 2.85) and previous laparotomy (AWS 2.83), respectively. Respondents also felt that the younger patients (AWS 0.78), dedicated operating team (AWS 0.67), BMI less than 35 (AWS 0.54), and French position (AWS 0.45) actually make the surgery easier. Conclusion This survey is the first attempt to understand the factors which make bariatric surgery more difficult. Knowing the factors made the operation more challenging, led to better scheduling the potentially difficult patients to reduce the complications.

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Thoracic cavity-to-cage ratio is a predictor of technical difficulties in minimally invasive esophagectomy

Abe

Oshikiri

Goto

et al. 2022

Surgery

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Predictive factors of difficulty of thoracoscopic esophagectomy in the left decubitus position

Cited by 4 publications

References 12 publications

Predictors of the difficulty of transcervical subcarinal lymph node dissection for esophageal cancer

Predictors of the difficulty of transcervical subcarinal lymph node dissection for esophageal cancer

Factors that make Bariatric Surgery Technically Challenging: A Survey of 370 Bariatric Surgeons

Thoracic cavity-to-cage ratio is a predictor of technical difficulties in minimally invasive esophagectomy

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