Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Surg Endosc. 2013 Jan;27(1):40-7. doi: 10.1007/s00464-012-2404-3. Epub 2012 Jun 30.
In 2009, the rate of thoracoscopic esophagectomy for esophageal cancer was about 20% in Japan. This low rate may be due to the difficulty in maintaining a good surgical field and the meticulous procedures that are required. The purpose of this study was to establish and evaluate a new procedure for performing a thoracoscopic esophagectomy while the patient is in a prone position using a preceding anterior approach to make the esophagectomy easier to perform.
We have performed thoracoscopic esophagectomy using our new procedure in 60 patients with esophageal cancer. Each patient was placed in a prone position and five trocars were inserted; only the left lung was ventilated and a pneumothorax was maintained. The esophagus was mobilized from the anterior structure during the first step and from the posterior structure during the second step. The lymph nodes around the esophagus were also dissected anteriorly and posteriorly. The patients were sequentially divided into two groups and their clinical outcomes were evaluated.
The mean operative time for the thoracoscopic procedure for the latter 30 cases (203 min) was shorter than that for the former 30 cases (260 min) (P = 0.001). Among the 52 cases without pleural adhesion, the mean blood loss in the latter 26 cases (18 mL) was also less than that in the former 26 cases (40 mL) (P = 0.027). There were no conversions to a thoracotomy and no operative deaths in this series. Postoperative complications related to the thoracoscopic procedure occurred in 8 cases (27%) in the former group and in 4 cases (13%) in the latter group.
Thoracoscopic esophagectomy with the patient in the prone position using a preceding anterior approach is a safe and feasible procedure. As experience performing the procedure increases, the performance of the procedure stabilizes. This method seems to make the esophagectomy easier to perform.
2009 年，日本电视辅助胸腔镜食管切除术的比例约为 20%。这种低比例可能是由于难以维持良好的手术视野和需要精细的手术步骤。本研究的目的是建立和评估一种新的方法，即在患者处于俯卧位时使用前置前入路进行胸腔镜食管切除术，以使食管切除术更容易进行。
我们在 60 例食管癌患者中使用新方法进行了胸腔镜食管切除术。每位患者均处于俯卧位，插入 5 个 trocar；仅左肺通气并保持气胸。在第一步中从前结构游离食管，在第二步中从后结构游离食管。还从前部和后部解剖食管周围的淋巴结。患者被分为两组，评估其临床结果。
后 30 例胸腔镜手术的平均手术时间（203 分钟）短于前 30 例（260 分钟）（P=0.001）。在无胸膜粘连的 52 例中，后 26 例的平均出血量（18 毫升）也少于前 26 例（40 毫升）（P=0.027）。本系列中无中转开胸，无手术死亡。前组 8 例（27%）和后组 4 例（13%）发生与胸腔镜手术相关的术后并发症。
在俯卧位使用前置前入路进行胸腔镜食管切除术是一种安全可行的方法。随着手术经验的增加，手术的稳定性提高。这种方法似乎使食管切除术更容易进行。
