Batirel Hasan
Thoracic Surgery Unit, Memorial Sisli Hospital, Istanbul, Turkey.
Front Surg. 2022 Mar 25;9:844796. doi: 10.3389/fsurg.2022.844796. eCollection 2022.
The adoption of minimally invasive esophagectomy has been used for over a decade, and the chest part is evolving into a uniportal video-assisted thoracoscopic surgery (VATS) approach. Uniportal esophageal mobilization and anastomosis have many peculiar aspects, which include placement of the incision, alignment of instruments, and anastomosis. The incision is placed over the sixth intercostal space posterior axillary line. The esophagus is usually encircled at the level of the inferior pulmonary vein. The use of curved suction helps in the retraction of the esophagus and the exposure of the left main bronchus deep in the mediastinum. For intrathoracic anastomosis in Ivor Lewis esophagectomy, a completely side-to-side linear-stapled anastomosis is preferred. This anastomotic technique results in a long stapler line. The correct alignment of tissues and adequate anastomotic circumference are of utmost importance to prevent leaks or strictures. Perioperative and oncologic results in several series with uniportal VATS, esophageal mobilization, and anastomosis are comparable with open or other types of minimally invasive esophagectomy. Uniportal VATS for esophagectomy is feasible and fast with good results.
微创食管切除术已应用了十多年，其胸部手术部分正逐渐演变为单孔电视辅助胸腔镜手术（VATS）方法。单孔食管游离和吻合有许多独特之处，包括切口位置、器械摆放和吻合方式。切口位于腋后线第六肋间。食管通常在肺下静脉水平处被环绕。使用弯形吸引器有助于牵拉食管并暴露纵隔深处的左主支气管。在Ivor Lewis食管切除术中进行胸内吻合时，完全侧侧线性吻合器吻合是首选。这种吻合技术会形成一条较长的吻合器缝线。组织的正确对合和足够的吻合周长对于防止漏血或狭窄至关重要。多个系列中采用单孔VATS进行食管游离和吻合的围手术期及肿瘤学结果与开放手术或其他类型的微创食管切除术相当。单孔VATS食管切除术可行且快速，效果良好。
