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Summary

Abstract

Introduction

Protocol

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References

Medicine

Low-Cost Single-Port (LoCoSP) Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Published: September 11th, 2021

DOI:

10.3791/62509

1Gastroenterology Department, University of São Paulo

Here, we describe a step-by-step description of transhiatal esophagectomy and the development of a low-cost single-port device for a transcervical approach in a minimally invasive transhiatal esophagectomy.

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains controversial. A transthoracic approach may improve lymph node dissection, but it has considerable morbidity and respiratory complications. Transhiatal access has been demonstrated as an efficient means of minimizing post-operative complications. Minimally invasive transhiatal esophagectomy may reduce operative trauma and morbidity as well as enhance postoperative recovery with no compromise in cancer recurrence or survival. Nevertheless, it has a technical limitation in terms of cervical esophagus dissection. Thus, a low-cost single-port device was developed to complete upper mediastinal dissection by a transcervical approach during minimally invasive transhiatal esophagectomy. This device uses a nasogastric tube, a number-eight sterile glove, a sterile sponge, and 3 permanent 5-mm trocars. The step-by-step process of transhiatal esophagectomy and the development of this device are described. This technique allows for the dissection of the upper mediastinum, as well as the esophagus over the aortic arch and behind the superior portion of the trachea. The harvesting of lymph nodes along the left recurrent laryngeal nerve and paratracheals was improved.

There are multiple options for the treatment of esophageal cancer, which involve endoscopy, surgery1, neoadjuvant, and definitive treatment with chemoradiotherapy2. Esophagectomy is the most important element in the curative treatment of patients with advanced esophageal cancer3, and the two main approaches currently used for surgical treatment are transthoracic esophagectomy (TTE) and transhiatal esophagectomy (THE). However, the choice of approach remains controversial. Since TTE requires pulmonary collapse during surgery, more frequent pulmonary complications are to be expected than in a transh....

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The surgical procedure and the protocol were explained to the patients, and they signed a consent form. This study was approved by the local ethics committees of the institutional review board and informed consent were collected from patients, register number 1688/20. Patients who underwent transhiatal esophagectomy were included in the protocol, while those patients who underwent a transthoracic approach were excluded.

1. Production of low-cost single-port device

  1. Use a nasogastric.......

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The LoCoSP device is a useful tool for safely dissecting the structures of the upper mediastinum. Direct visualization of the cervical and upper thoracic esophagus allows for safe dissection with less risk of tracheal injury and hemorrhage from tearing of the larger vessels, in addition to improving the lymphadenectomy of the left recurrent laryngeal and paratracheal nodes.

From 2018 to 2020, 12 patients with distal esophageal carcinoma (2 squamous cell carcinoma and 10 adenocarcinoma) were su.......

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The LoCoSP device allows for safer surgery using a transcervical approach in minimally invasive THE. This is accomplished by improving the recognition and dissection of the esophagus, trachea, and the aortic arch under magnified vision. The advantages of THE are amplified. In addition to allowing surgery with less morbidity and fewer pulmonary complications, this technique can improve the dissection of left paratracheal and recurrent lymph nodes. Another advantage of this technique is that it is possible to reduce the ri.......

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None.

....

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Name Company Catalog Number Comments

  1. Borggreve, A. S., et al. Surgical treatment of esophageal cancer in the era of multimodality management. Annals of the New York Academy of Sciences. 1434 (1), 192-209 (2018).
  2. Kato, H., Nakajima, M. Treatments for esophageal cancer: a review. General Thoracic and Cardiovascular Surgery. 61 (6), 330-335 (2013).
  3. Rice, T. W., Patil, D. T., Blackstone, E. H. 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction application to clinical practice. Annalsof Cardiothoracic Surgery. 6 (2), 119-130 (2017).
  4. Hulscher, J. B., Tijssen, J. G., Obertop, H., van Lanschot, J. J. Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Annals of Thoracic Surgery. 72 (1), 306-313 (2001).
  5. Rentz, J., et al. Transthoracic versus transhiatal esophagectomy: a prospective study of 945 patients. Journal of Thoracic and Cardiovascular Surgery. 125 (5), 1114-1120 (2003).
  6. Tokairin, Y., et al. Mediastinoscopic subaortic and tracheobronchial lymph node dissection with a new cervico-hiatal crossover approach in thiel-embalmed cadavers. International Surgery. 100, 580-588 (2015).
  7. Fujiwara, H., et al. Single-port mediastinoscopic lymphadenectomy along the left recurrent laryngeal nerve. Annals of Thoracic Surgery. 100 (3), 1115-1117 (2015).
  8. Gupta, V., et al. Major airway injury during esophagectomy: experience at a tertiary care center. Journal of Gastrointestinal Surgery. 13 (3), 438-441 (2009).
  9. Hulscher, J. B., et al. Injury to the major airways during subtotal esophagectomy: incidence, management, and sequelae. Journal of Thoracic and Cardiovascular Surgery. 120 (6), 1093-1096 (2000).
  10. Fermin, L., Arnold, S., Nunez, L., Yakoub, D. Extracorporeal membrane oxygenation for repair of tracheal injury during transhiatal esophagectomy. Annals of Cardiac Anaesthesia. 20, 67-69 (2017).

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