Abstract
Purpose
Two-stage minimally invasive esophagectomy (MIE) has gained popularity in the surgical treatment of esophageal cancer. MIE’s limitation is embedded in the construction of intrathoracic anastomosis. Various anastomotic techniques have been reported; however, the mechanical one remains the most commonly adopted. This pilot study aims to describe an efficient, safe, and reproducible way of performing a hand-sewn intrathoracic esophagogastric anastomosis in conjunction with short-term results using 2D and 3D thoracoscopic approaches.
Methods
A total of n = 13 patients (mean age 67.4) underwent MIE for distal esophageal or gastroesophageal junction adenocarcinoma between January and September 2016. Resection was performed in prone position, and the esophagogastric anastomosis was constructed in an end-to-side manner in two layers with barbed knotless suture. A 2D thoracoscopic approach was used in n = 10 patients (77%) and a 3D approach in n = 3 (23%).
Results
n = 8 patients (61.5%) had neo-adjuvant chemotherapy and n = 5 (38.5%) had primary surgery. The mean operating time was 420 min, and the average length of stay was 10 days with no associated mortality. n = 1 (7.7%) developed a radiological leak that did not require an intervention. Thoracoscopic approach with the glasses-based 3D optical system using the angulating-tip 100° camera provided a far superior view for precise lymphadenectomy in combination to an efficient and safe construction of the anastomosis.
Conclusion
The barbed knotless suturing technique in MIE is an efficient and safe method of constructing the esophagogastric anastomosis with promising short-term outcomes. A 3D thoracoscopic approach appears to be superior in performing the anastomosis to that of a 2D technique.
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Authors’ contributions
Alexandros Charalabopoulos: study conception and design, acquisition of data, analysis and interpretation of data, and drafting of manuscript; Bruno Lorenzi: acquisition of data and analysis and interpretation of data; Ali Kordzadeh: analysis and interpretation of data; Cheuk-Bong Tang: analysis and interpretation of data; Sritharan Kadirkamanathan: critical revision of manuscript; and Naga Venkatesh Jayanthi: acquisition of data and critical revision of manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Charalabopoulos, A., Lorenzi, B., Kordzadeh, A. et al. Role of 3D in minimally invasive esophagectomy. Langenbecks Arch Surg 402, 555–561 (2017). https://doi.org/10.1007/s00423-017-1570-0
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DOI: https://doi.org/10.1007/s00423-017-1570-0