Minimally invasive oesophagectomy presentation of our technique
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Minimally Invasive Oesophagectomy Presentation οf Our Technique D. Bistarakis, S. Krivan, K. Petropoulos, A. Bakopoulos, V. Zymvragoudakis, T. Liakakos
Abstract Aim-Background To present a thoraco-laparoscopic total oesophagectomy. Oesophagectomy is a formidable surgical
procedure. For malignancies, oesophagectomy with thoracotomy accomplishes complete resection of the tumour and surrounding lymph nodes but is associated with a significant perioperative mortality. Nowadays, minimally invasive oesophagectomy is being used, although the technique has been described since 1992. Methods A 63- year-old male, obese (BMI 38), smoker, with a history of arterial hypertension, chronic obstructive pulmonary disease, chronic renal failure and hiatal hernia of 40 years was admitted with an adenocarcinoma of the oesophagus at 28cm on Barrett's oesophagus. Endoscopic ultrasound showed invasion of the submucosa but no lymph node enlargement. Computer tomography revealed no metastases. The patient underwent a thoraco-laparoscopic total oesophagectomy with two-field lymph node resection and gastric tube formation to replace the oesophagus. Results The operating time was 330 min, and blood loss was < 50ml. The patient was extubated in the operating theatre and remained in the Intensive Care Unit for 16 hours. His postoperative course was uneventful. He was discharged at day 10. The pathology report showed adenocarcinoma of the oesophagus Τ1βΝ0 (0/59). Sixteen months later, the patient remains disease-free. Conclusions Minimally invasive oesophagectomy is feasible and can provide complete resection of the tumour
comparable to that of an open procedure with less blood loss and probably fewer complications. To achieve this result, an organised and experienced team is a mandatory requirement. Key words oesophagectomy, minimally invasive, thoraco-laparoscopic, less blood loss, fewer complications, prone position
Introduction-Aim Oesophageal carcinoma is on the increase due to the rising incidence of adenocarcinoma. Oesophagectomy is a formidable surgical procedure associated with a relatively high risk of morbidity and mortality. Furthermore, it requires a long stay in the intensive care unit, a lengthy in-hospital stay and extensive recovery period. [1] Indications for such a procedure are mainly malignant tumours. Oesophagectomy performed via thoracotomy was originally adopted at the beginning of the 20th century and has been widely used ever since. For malignancies, oesophagectomy with thoracotomy accomplishes complete resection of the tumour and surrounding lymph nodes but is associated with significant perioperative mortality, due especially to respiratory system complications. An alternative method D. Bistarakis, S. Krivan, K. Petropoulos, A. Bakopoulos, V. Zymvragoudakis, T. Liakakos 3rd Surgical Department of University Hospital of “Attikon”, Αthens Corresponding author: Sylvia Krivan, Tel.: +30 6932917927, fax: +30 2105988180 E-mail: [email protected], Received 16 Jan 2013; Accepted 14 March 2013
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