Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
Surg Endosc. 2010 Dec;24(12):2965-73. doi: 10.1007/s00464-010-1072-4. Epub 2010 May 22.
A thoracoabdominal esophagectomy for esophageal cancer is a severely invasive procedure. A thoracoscopic esophagectomy may minimize injury to the chest wall and reduce surgical invasiveness. Conventional thoracoscopic procedures are performed in the left lateral-decubitus position. Recently, procedures performed in the prone position have received more attention because of improvements in operative exposure or surgeon ergonomics. However, the efficacy of the prone position in an aggressive thoracoscopic esophagectomy with an extensive lymphadenectomy has not been fully documented.
We successfully performed a thoracoscopic esophagectomy with a three-field extensive lymphadenectomy in 43 esophageal carcinoma patients in the prone position from December 2007 to December 2009. We describe our procedures with the patients in the prone position, focusing especially on a lymphadenectomy along the left recurrent laryngeal nerve where the nodes are frequently involved and precise dissection is technically challenging. To determine further the advantages of this position, we retrospectively compared surgical outcomes in 43 patients to those of 34 patients who underwent a thoracoscopic esophagectomy in the left lateral decubitus position as a historical control from January 2006 to November 2007.
It was easier to explore the operative field around the left recurrent laryngeal nerve during a thoracoscopic esophagectomy in the prone position. The mean duration of the aggressive thoracoscopic procedure in the prone position was 307 min, which was significantly longer than in the left lateral decubitus position, but the total estimated blood loss in the prone position was significantly lower. There was no difference in the incidence of postoperative complications between the two procedures.
A thoracoscopic esophagectomy in the prone position is technically safe and feasible and provides better surgeon ergonomics and better operative exposure around the left recurrent laryngeal nerve during an aggressive esophagectomy.
胸腹腔镜食管癌切除术是一种严重的侵袭性手术。胸腔镜食管切除术可以最大限度地减少对胸壁的损伤，降低手术的侵袭性。传统的胸腔镜手术是在左侧卧位进行的。最近，由于手术显露或外科医生操作舒适度的改善，俯卧位手术受到了更多的关注。然而，在广泛淋巴结清扫的积极胸腔镜食管切除术中，俯卧位的疗效尚未得到充分证实。
我们成功地为 43 例食管癌患者在俯卧位进行了胸腔镜食管切除术和三野广泛淋巴结清扫术。我们描述了我们在俯卧位下的手术程序，特别关注沿左侧喉返神经进行的淋巴结清扫，因为该区域的淋巴结经常受累，且精确解剖具有技术挑战性。为了进一步确定该体位的优势，我们回顾性地比较了 43 例在俯卧位下行胸腔镜食管切除术的患者与 2006 年 1 月至 2007 年 11 月在左侧卧位下行胸腔镜食管切除术的 34 例患者的手术结果。
在俯卧位下进行胸腔镜食管切除术时，更容易探查左侧喉返神经周围的手术区域。俯卧位下积极胸腔镜手术的平均时间为 307 分钟，明显长于左侧卧位，但俯卧位的总估计出血量明显减少。两种手术的术后并发症发生率无差异。
俯卧位下的胸腔镜食管切除术在技术上是安全可行的，并且在积极的食管切除术中为外科医生提供了更好的操作舒适度和更好的左侧喉返神经手术显露。
Zotero 插件