Department of Gastrointestinal Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara- machi, Kanazawa, 920-8641, Ishikawa, Japan.
Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinadamachi, Kahoku, 920-0293, Ishikawa, Japan.
BMC Surg. 2023 Aug 18;23(1):242. doi: 10.1186/s12893-023-02131-2.
The degree of difficulty in the overall procedure and forceps handling encountered by surgeons is greatly influenced by the positional relationship of intrathoracic organs in minimally invasive esophagectomy. This study aimed to identify the anatomical factors associated with the difficulty of minimally invasive esophagectomy assessed by intraoperative injuries and postoperative outcomes.
Minimally invasive esophagectomy in the left-decubitus position was performed in 258 patients. We defined α (mm) as the anteroposterior distance between the front of the vertebral body and aorta, β (mm) as the distance between the center of the vertebral body and center of the aorta, and γ (degree) as the angle formed at surgeon's right-hand port site by insertion of lines from the front of aorta and from the front of vertebrae in the computed tomography slice at the operator's right-hand forceps hole level. We retrospectively analyzed the correlations among clinico-anatomical factors, surgeon- or assistant-caused intraoperative organ injuries, and postoperative complications.
Intraoperative injuries significantly correlated with shorter α (0.2 vs. 3.9), longer β (33.0 vs. 30.5), smaller γ (3.0 vs. 4.3), R1 resection (18.5% vs. 8.3%), and the presence of intrathoracic adhesion (46% vs. 26%) compared with the non-injured group. Division of the median values into two groups showed that shorter α and smaller γ were significantly associated with organ injury. Longer β was significantly associated with postoperative tachycardia onset, respiratory complications, and mediastinal recurrence. Furthermore, the occurrence of intraoperative injuries was significantly associated with the onset of postoperative pulmonary complications.
Intrathoracic anatomical features greatly affected the procedural difficulty of minimally invasive esophagectomy, suggesting that preoperative computed tomography simulation and appropriate port settings may improve surgical outcomes.
微创食管切除术（MIE）中，胸腔内器官的位置关系极大地影响了外科医生在整个手术过程中遇到的难度和使用器械的难度。本研究旨在确定与微创食管切除术中术中损伤和术后结果相关的解剖因素。
对 258 例左卧位 MIE 患者进行研究。我们将α（mm）定义为椎体前缘与主动脉前缘之间的前后距离，β（mm）定义为椎体中心与主动脉中心之间的距离，γ（度）定义为在术者右手操作孔层面的 CT 切片上，从主动脉前缘和椎体前缘插入线在术者右手器械孔处形成的角度。我们回顾性分析了临床解剖因素、术者或助手引起的术中器官损伤以及术后并发症之间的相关性。
术中损伤与较短的α（0.2 比 3.9）、较长的β（33.0 比 30.5）、较小的γ（3.0 比 4.3）、R1 切除（18.5%比 8.3%）和胸腔内粘连（46%比 26%）显著相关。将中位数分为两组，结果显示较短的α和较小的γ与器官损伤显著相关。较长的β与术后心动过速发作、呼吸并发症和纵隔复发显著相关。此外，术中损伤的发生与术后肺部并发症的发生显著相关。
胸腔内解剖特征极大地影响了微创食管切除术的手术难度，提示术前 CT 模拟和适当的端口设置可能改善手术结果。
