Simplifying minimally invasive transhiatal esophagectomy with the inversion approach - Lessons learned from the first 20 cases

被引:26
作者
Jobe, Blair A.
Kim, Charles Y.
Minjarez, Renee C.
O'Rourke, Robert
Chang, Eugene Y.
Hunter, John G.
机构
[1] Oregon Hlth & Sci Univ, Dept Surg, Portland, OR USA
[2] Portland VA Med Ctr, Surg Serv, Portland, OR USA
关键词
D O I
10.1001/archsurg.141.9.857
中图分类号
R61 [外科手术学];
学科分类号
摘要
Hypothesis: The laparoscopic transhiatal esophagectomy can be simplified and performed safely and effectively by using a novel esophageal inversion technique. Design: Case series describing technique, initial experience, and learning curve with laparoscopic inversion esophagectomy. Setting: Tertiary care university hospital and veteran's hospital. Patients: Twenty consecutive patients with high-grade dysplasia (n = 16) and esophageal adenocarcinoma (n=4). Intervention: Laparoscopic inversion esophagectomy, a totally laparoscopic approach to transhiatal esophagectomy that incorporates distal to proximal inversion to improve mediastinal exposure and ease of dissection. Main Outcome Measures: Perioperative end points and complications, compared between the first and second groups of 10 patients. Results: There were 19 men and 1 woman. Median operative time was 448 minutes. Median blood loss was 175 cull. Median intensive care unit stay was 4 days, and median total hospital stay was 9 days. Overall anastomotic leak rate was 20%. Five patients developed an anastomotic stricture, all successfully managed with endoscopic dilation. There were 2 recurrent laryngeal nerve injuries, which resolved. There was no intraoperative or 30-day mortality. Between the first 10 consecutive cases and last 10 procedures, the incidence of anastomotic leak and stricture formation decreased from 30% to 10% and 40% to 10%, respectively. During this period, the number of lymph nodes harvested increased 9-fold, and duration of intensive care unit stay decreased from 8.00 to 2.50 days. Conclusions: Laparoscopic inversion esophagectomy is a safe procedure. The learning curve for the inversion approach is approximately 10 operations in the hands of esophageal surgeons with advanced laparoscopic expertise.
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页码:857 / 865
页数:9
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