Galaxy Laparoscopy Institute, 25A Karve Road, Near Garware College, Pune, 411004, India.
Surg Endosc. 2010 Oct;24(10):2407-14. doi: 10.1007/s00464-010-0963-8. Epub 2010 Mar 5.
Esophagectomy has been performed using a thoracoabdominal, transhiatal, or transthoracic approach. All these methods have an acknowledged high intra- and postoperative morbidity. The principle of minimally invasive esophagectomy is to perform the operation the same as by the open approach but through a smaller incision, thus reducing the operative trauma without compromising the principles of the operation. The authors report their experience with thoracoscopic esophagectomy performed for 112 patients in left lateral position.
Patients with resectable thoracic or gastroesophageal junction cancer and medically fit for a three-stage esophagectomy underwent thoracoscopic esophagectomy in left lateral position. The procedure was converted to open surgery for 2 (1.79%) of the 112 patients.
Since June 2005, 112 patients have undergone thoracoscopic esophagectomy in left lateral position. Of these patients, 80 patients had middle-third esophageal cancer. The pathology of 100 patients showed squamous cell carcinoma. The average thoracoscopic operating time was 85 min (range, 40-120 min). The average blood loss was 200 ml, and the average number of harvested mediastinal nodes was 20. Postoperative morbidity occurred for 16 patients, with 8 patients (7.27%) experiencing respiratory complications. Postoperative mortality was experienced by three patients. The median follow-up period was 18 months.
Thoracoscopic esophagectomy is surgically safe and oncologically adequate. Thoracoscopy for patients in the left lateral position does not require prolonged single-lung ventilation. The anatomic orientation in the left lateral position is the same as that for open surgery, reducing the learning curve for thoracic surgeons. The potential advantages and the morbidity trend of prone instead of left lateral thoracoscopic esophagectomy needs to be evaluated.
食管癌切除术可通过胸腹、经食管裂孔或经胸途径进行。所有这些方法都有公认的高围手术期发病率。微创食管切除术的原则是通过更小的切口进行与开放手术相同的操作，从而减少手术创伤，而不影响手术原则。作者报告了他们在左侧卧位下为 112 例患者施行胸腔镜食管切除术的经验。
对于可切除的胸段或胃食管交界处癌症且适合三阶段食管切除术的患者，行左侧卧位胸腔镜食管切除术。112 例患者中有 2 例（1.79%）转为开放手术。
自 2005 年 6 月以来，112 例患者行左侧卧位胸腔镜食管切除术。其中 80 例患者为中段食管癌。100 例患者的病理结果显示为鳞状细胞癌。胸腔镜手术平均时间为 85 分钟（范围 40-120 分钟）。平均出血量为 200ml，平均采集纵隔淋巴结数为 20 个。16 例患者发生术后并发症，其中 8 例（7.27%）出现呼吸并发症。3 例患者术后死亡。中位随访时间为 18 个月。
胸腔镜食管切除术在手术上是安全的，且在肿瘤学上是充分的。左侧卧位胸腔镜不需要长时间的单肺通气。左侧卧位的解剖方位与开放手术相同，减少了胸腔外科医生的学习曲线。需要评估俯卧位而不是左侧卧位胸腔镜食管切除术的潜在优势和发病趋势。
