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

Summary

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.

Abstract

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.

Introduction

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....

Protocol

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.......

Discussion

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.......

Materials

Name	Company	Catalog Number	Comments