400. CONSTRUCTION OF A MODULAR SYSTEM OF ‘INFLATABLE SINGLE-INCISION MEDIASTINOSCOPY ESOPHAGECTOMY’ BASED ON FASCIA ANATOMY

Abstract

Abstract Background We improved Inflatable Single-Incision Mediastinoscopy esophagectomy to implement the simultaneous laparoscopic esophagectomy with inflatablesingle-Incision mediastinoscope and lymphadenectomy along bilateral recurrent laryngeal nerves under mediastinoscopy through a single left-neck incision and formed the concept of modular treatment of inflatable mediastinoscopic esophagectomy based on fascial anatomy which we can achieve standardized add programmed esophageal dissociation, greatly shorten the learning curve, make it easier to popularize and promote, and help us to control the operation time and complications. Methods According to anatomy of the periesophageal fascia we summarized six surgical modules, respectively is: To make the neck incision, dissociate posterior and left esophagus, dissociate anterior and right esophagus, lymphadenectomy along left recurrent laryngeal nerves, lymphadenectomy along right recurrent laryngeal nerves, dissect the Subcarinal lymph nodes. The clinical data of patients undergoing esophagectomy with inflatable single-pore mediastinoscope from February 2020 to February 2021 in our hospital were summarized and analyzed, and compared with the data of minimally invasive thoracic esophagectomy, in order to verify the clinical application effect of this modular system. Results In the validation study of modularization in this subject, no perioperative death was found in the 44 patients and the R0 resection rate was 100% confirmed by postoperative pathology. The average operation time was 204.9 ± 45.4 minutes, mean intraoperative blood loss was 64.6 ± 45.5 mL, average number of lymph nodes removed was 19.5 ± 9.1, average length of hospital stay was 27.0 ± 18.17 days, postoperative anastomotic fistula (2.27%), anastomotic stenosis (13.64%), chylous leakage (0%), pleural effusion (4.55%), and pulmonary infection (9.09%), better than the control group. The incidence of postoperative hoarseness (18.19%) which needed to be improved. Conclusion This standardized and modular surgical procedure description based on fascia anatomy is proposed for the first time for the esophagectomy under inflatable mediastinoscope, and is an exploration of the construction of a modular system for this surgical procedure. This modular system enables us to achieve standardized, programmed and rapid esophageal dissociation, which has good clinical application value.