Transcervical videoscopic esophageal dissection during two-field minimally invasive esophagectomy

Early patient experience

Michael Parker, Steven P. Bowers, Ross F. Goldberg, Jason M. Pfluke, John A. Stauffer, Horacio J. Asbun, C. Daniel Smith

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Transhiatal (two-field) esophagectomy reduces cardiopulmonary complications by avoiding thoracic access, but requires blind mediastinal dissection. The authors developed a minimally invasive esophagectomy (MIE) technique applying single-incision laparoscopy technology to better visualize the thoracic esophageal dissection. This is performed using laparoscopy and simultaneous transcervical videoscopic esophageal dissection (TVED). Our aim is to demonstrate feasibility of two-field MIE with TVED and improve recovery in high-risk patients. Methods: We performed a retrospective cohort study of eight patients who underwent two-field MIE with TVED over 10 months. The majority were male (N = 6) with mean age of 63 ± 12 years. Mean body mass index (BMI) was 30.2 ± 5.1 kg/m 2. Indications for operation were: high-grade dysplasia (N = 2), adenocarcinoma (N = 6) with one receiving neoadjuvant chemoradiation. Using the Charlson comorbidity index, three patients were low risk and five were high risk. TVED was performed with a modified single-incision access device across the left neck. The mediastinal esophagus was dissected distally and circumferentially with simultaneous transabdominal laparoscopy for gastric conduit creation and distal esophageal dissection. Results: Mean operative time was 292 min (range 194-375 min). Three obese patients required temporary abdominal desufflation to avoid extrinsic mediastinal compression. Mean estimated blood loss was 119 mL (range 25-400 mL). A median of 23 lymph nodes (range 13-29) was harvested. Median intensive care unit (ICU) stay was 1 day (range 1-5 days), and median overall stay was 7 days (range 5-16 days). The three low-risk patients had no major complications. Three of five high-risk patients had major complications, including two cervical anastomotic leaks. Major complications were seen in three of four obese patients (BMI >30 kg/m 2). There were no mortalities. Conclusions: The TVED approach may avoid the morbidity of transthoracic esophageal dissection by improving esophageal visualization. Complications with TVED appear to correlate with obesity and comorbidities. Although TVED appears feasible, a larger experience is required.

Original languageEnglish (US)
Pages (from-to)3865-3869
Number of pages5
JournalSurgical Endoscopy and Other Interventional Techniques
Volume25
Issue number12
DOIs
StatePublished - Dec 2011

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Esophagectomy
Dissection
Laparoscopy
Comorbidity
Body Mass Index
Thorax
Anastomotic Leak
Operative Time
Esophagus
Intensive Care Units
Stomach
Adenocarcinoma
Cohort Studies
Neck
Retrospective Studies
Obesity
Lymph Nodes
Technology
Morbidity

Keywords

  • Barrett's
  • Esophageal cancer
  • Esophagectomy
  • Laparoscopy
  • Minimally invasive esophagectomy
  • Single-incision laparoscopy

ASJC Scopus subject areas

  • Surgery

Cite this

Transcervical videoscopic esophageal dissection during two-field minimally invasive esophagectomy : Early patient experience. / Parker, Michael; Bowers, Steven P.; Goldberg, Ross F.; Pfluke, Jason M.; Stauffer, John A.; Asbun, Horacio J.; Daniel Smith, C.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 25, No. 12, 12.2011, p. 3865-3869.

Research output: Contribution to journalArticle

Parker, Michael ; Bowers, Steven P. ; Goldberg, Ross F. ; Pfluke, Jason M. ; Stauffer, John A. ; Asbun, Horacio J. ; Daniel Smith, C. / Transcervical videoscopic esophageal dissection during two-field minimally invasive esophagectomy : Early patient experience. In: Surgical Endoscopy and Other Interventional Techniques. 2011 ; Vol. 25, No. 12. pp. 3865-3869.
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T2 - Early patient experience

AU - Parker, Michael

AU - Bowers, Steven P.

AU - Goldberg, Ross F.

AU - Pfluke, Jason M.

AU - Stauffer, John A.

AU - Asbun, Horacio J.

AU - Daniel Smith, C.

PY - 2011/12

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N2 - Background: Transhiatal (two-field) esophagectomy reduces cardiopulmonary complications by avoiding thoracic access, but requires blind mediastinal dissection. The authors developed a minimally invasive esophagectomy (MIE) technique applying single-incision laparoscopy technology to better visualize the thoracic esophageal dissection. This is performed using laparoscopy and simultaneous transcervical videoscopic esophageal dissection (TVED). Our aim is to demonstrate feasibility of two-field MIE with TVED and improve recovery in high-risk patients. Methods: We performed a retrospective cohort study of eight patients who underwent two-field MIE with TVED over 10 months. The majority were male (N = 6) with mean age of 63 ± 12 years. Mean body mass index (BMI) was 30.2 ± 5.1 kg/m 2. Indications for operation were: high-grade dysplasia (N = 2), adenocarcinoma (N = 6) with one receiving neoadjuvant chemoradiation. Using the Charlson comorbidity index, three patients were low risk and five were high risk. TVED was performed with a modified single-incision access device across the left neck. The mediastinal esophagus was dissected distally and circumferentially with simultaneous transabdominal laparoscopy for gastric conduit creation and distal esophageal dissection. Results: Mean operative time was 292 min (range 194-375 min). Three obese patients required temporary abdominal desufflation to avoid extrinsic mediastinal compression. Mean estimated blood loss was 119 mL (range 25-400 mL). A median of 23 lymph nodes (range 13-29) was harvested. Median intensive care unit (ICU) stay was 1 day (range 1-5 days), and median overall stay was 7 days (range 5-16 days). The three low-risk patients had no major complications. Three of five high-risk patients had major complications, including two cervical anastomotic leaks. Major complications were seen in three of four obese patients (BMI >30 kg/m 2). There were no mortalities. Conclusions: The TVED approach may avoid the morbidity of transthoracic esophageal dissection by improving esophageal visualization. Complications with TVED appear to correlate with obesity and comorbidities. Although TVED appears feasible, a larger experience is required.

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