Thoracoscopic esophageal mobilization during minimally invasive esophagectomy: a head-to-head comparison of prone versus decubitus positions

Fabian, Thomas; Martin, Jeremiah T.; Katigbak, Mario; McKelvey, Alicia A.; Federico, John A.

doi:10.1007/s00464-008-9799-x

Cited by 100 publications

(101 citation statements)

References 11 publications

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“…Fabian et al indicated the results of prone positioning to be equivalent to lateral decubitus in terms of blood loss, lymph node dissection, and complications and reported significantly shorter operative duration in prone position. The authors concluded that conversion to open thoracotomy may be easier in lateral position (11). But, the previous studies did not give any preference to any of the two methods (3).…”

Section: Discussionmentioning

confidence: 97%

Thoracoscopic Esophagectomy in Supine Position

Abdollahi

Alipour

Tavassoli

et al. 2015

J Minim Invasive Surg Sci

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Background: Esophageal cancer needs major surgery due to its anatomic position, which is followed by high morbidity in most patients. Thoracotomy, a previously used method, was accompanied by high pulmonary complications, had physical limitations, and low tolerance of patients. Thoracoscopic esophagectomy is a new suitable method with less morbidity. Objectives: The present study aimed to investigate the results of performing three phases of esophagectomy through laparoscopy and thoracoscopy in supine position without frequent changes in patients' position. Patients and Methods: This is a prospective study of 15 selected patients who underwent laparoscopic thoracoscopic esophagectomy and received preoperative radiotherapy between 2010 and 2011. At first, laparoscopic gastrolysis was carried out and then, transhiatal esophageal release was performed (up to the upper region); thereafter the upper esophagus was exposed by thoracoscopy in supine position and easily released. Results: The mean duration of esophagectomy was 70 minutes and the total operation 180 minutes. The mean amount of bleeding during surgery was 250 cc. Conversion to open approach occurred only in one patient out of 15. No cases of anastomotic leakage or pneumonia was observed. Also, no case of mortality was reported. Conclusions: Thoracoscopic esophagectomy can be easily performed in supine position and in a short time. .

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Section: Discussionmentioning

confidence: 97%

Thoracoscopic Esophagectomy in Supine Position

Abdollahi

Alipour

Tavassoli

et al. 2015

J Minim Invasive Surg Sci

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“…Prone positioning during thoracoscopic or robotic mobilization of the esophagus provides several advantages to the surgeon over the lateral decubitus position [1][2][3]. Prone positioning allows gravity to provide optimal exposure of the esophagus, and thus superb surgical view, because the lung falls away with minimal handling [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

“…Prone positioning allows gravity to provide optimal exposure of the esophagus, and thus superb surgical view, because the lung falls away with minimal handling [1][2][3]. When assuring free abdominal and chest movements, the prone position does not significantly affect the respiratory system compliance and hemodynamics and improves oxygenation during general anesthesia [6,15,16].…”

Section: Discussionmentioning

confidence: 99%

“…Conclusion PCV provides no advantages compared with VCV with regard to respiratory and hemodynamic variables during OLV in the prone position. Either ventilatory mode can be safely used for patients who undergo robotassisted esophagectomy and who have normal body mass index and preserved pulmonary function.Keywords Minimally invasive esophagectomy Á One-lung ventilation Á Oxygenation Á Prone position Á Pressure-controlled ventilation Á Volume-controlled ventilation Prone positioning during robotic mobilization of the esophagus for minimally invasive esophagectomy (MIE) provides several advantages, including shortened operative times and superior surgical view, at the cost of one-lung ventilation (OLV) [1][2][3]. Surgical positions considerably influence the deterioration speed and the nadir value of arterial oxygen tension (PaO 2 ) after the start of OLV [4].…”

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confidence: 99%

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Pressure-controlled versus volume-controlled ventilation during one-lung ventilation in the prone position for robot-assisted esophagectomy

Choi

Shim

et al. 2009

Surg Endosc

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Background The prone position during robotic esophageal mobilization for minimally invasive esophagectomy (MIE) provides several advantages with regards to operative times, surgeon ergonomics, and surgical view; however, this technique requires one-lung ventilation (OLV). There are no guidelines about ventilatory modes during OLV in the prone position. We investigated the effects of volume-controlled (VCV) and pressurecontrolled ventilation (PCV) on oxygenation and intrapulmonary shunt during OLV in the prone position in patients who underwent robot-assisted esophagectomy. Methods Eighteen patients, no major obstructive or restrictive pulmonary disease, were allocated randomly to one of two groups. In the first group (n = 9), OLV was started by VCV and the ventilator was switched to PCV after 30 minutes. In the second group (n = 9), the modes of ventilation were performed in the opposite order in the prone position. Hemodynamic and respiratory variables were obtained during OLV at the end of each ventilatory mode. Results There were no significant differences in arterial oxygen tension (PaO 2 ), airway pressures, dynamic lung compliance, or physiologic dead space (Vd/Vt) during OLV between PCV and VCV in the prone position. Intrapulmonary shunt (Qs/Qt) was significantly lower with VCV than with PCV during OLV in the prone position (p = 0.044). Conclusion PCV provides no advantages compared with VCV with regard to respiratory and hemodynamic variables during OLV in the prone position. Either ventilatory mode can be safely used for patients who undergo robotassisted esophagectomy and who have normal body mass index and preserved pulmonary function.Keywords Minimally invasive esophagectomy Á One-lung ventilation Á Oxygenation Á Prone position Á Pressure-controlled ventilation Á Volume-controlled ventilation Prone positioning during robotic mobilization of the esophagus for minimally invasive esophagectomy (MIE) provides several advantages, including shortened operative times and superior surgical view, at the cost of one-lung ventilation (OLV) [1][2][3]. Surgical positions considerably influence the deterioration speed and the nadir value of arterial oxygen tension (PaO 2 ) after the start of OLV [4]. The development of hypoxemia during OLV depends mainly on the intrapulmonary shunt (Qs/Qt) through the nonventilated lung and matching of the ratio of ventilation and perfusion (V/Q) in the ventilated lung. In contrast to the lateral decubitus position, OLV in the prone position is devoid of the beneficial effect of gravity on preferential redistribution of the pulmonary blood flow to the dependent areas of a lung, possibly resulting in increased V/Q mismatch [4,5]. Also, the prone position is frequently associated with decreased respiratory compliance and

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“…47) This longer time is unlikely due to the increased difficulty of and unfamiliarity with positioning patients in the prone position. On the contrary, Fabian, et al 48) and Feng, et al 49) showed that the thoracoscopic procedure is performed significantly more quickly in the prone position. Since the number of procedures performed per institution is relatively small, data directly comparing PP to the LDP technique are particularly sparse.…”

Section: Surgical Outcomes Of the Prone Proceduresmentioning

confidence: 99%

Thoracoscopic Esophagectomy Using Prone Positioning

Noshirο

Miyake

2013

ATCS

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Thoracotomic esophagectomy followed by cervical and abdominal procedures has been conventionally performed as the best curable operative procedure for treating invasive thoracic esophageal carcinoma. Despite improvements in the survival rate, the procedure is associated with significant operative morbidity and mortality rates due to the extreme invasiveness of an extensive dissection of the lymph nodes. Minimally invasive esophagectomy (MIE) was developed to reduce surgical invasiveness. Recently, the use of thoracoscopic esophagectomy performed in the prone position has stimulated new interest in minimally invasive approaches. However, the advantages and disadvantages of this technique are not well known. In this review, the literature to date, including series and comparative studies of minimally invasive esophagectomy performed in the prone position, is summarized, and the various lessons learned and controversies surrounding this technique are addressed.

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Thoracoscopic esophageal mobilization during minimally invasive esophagectomy: a head-to-head comparison of prone versus decubitus positions

Abstract: Prone thoracoscopic esophageal mobilization appears to be equivalent to decubitus thoracoscopic esophageal mobilization with respect to blood loss, number of lymph nodes dissected, and complications, but with a significant reduction in thoracoscopic surgical time.

Cited by 100 publications

References 11 publications

Thoracoscopic Esophagectomy in Supine Position

Thoracoscopic Esophagectomy in Supine Position

Pressure-controlled versus volume-controlled ventilation during one-lung ventilation in the prone position for robot-assisted esophagectomy

Thoracoscopic Esophagectomy Using Prone Positioning

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