P180 OPTIMIZING UPPER MEDIASTINAL LYMPHADENECTOMY DURING MINIMALLY INVASIVE OESOPHAGECTOMY IN PRONE POSITION: FROM 2D THORACOSCOPY AND DOUBLE LUMEN (DL) ENDOTRACHEAL TUBE VENTILATION TO 3D THORACOSCOPY AND SINGLE LUMEN (SL) TUBE VENTILATION

Abstract

Abstract Aim Upper mediastinal lymphadenectomy is a fundamental step of a radical oesophagectomy. Nodal dissection around the recurrent laryngeal nerves may be difficult and different approaches have been described in minimally invasive surgery. We describe our experience including recent technological advancements leading to improved outcomes. Background & Methods A retrospective analysis was performed among patients who underwent minimally invasive oesophageal resection for cancer including upper mediastinal lymphadenectomy between January 2016 and October 2018 at our Regional Centre for Oesophago-gastric Surgery (Broomfield Hospital, Chelmsford). A comparison between the initial cases performed using 2D thoracoscopy and DL endotracheal tube ventilation vs the more recent ones adopting 3D technology and SL tube ventilation was carried out. Length of operative time for this part of the operation, number of nodes removed and related peri-operative complications were among the data collected. Results A total of 14 patients were included in the study. 2D thoracoscopy and DL endotracheal tube ventilation was used in 10 patients whilst 3D technology and SL tube ventilation was adopted in 4 cases. Operative time was reduced in the 3D group. Complications related to upper mediastinal lymphadenectomy were noted in 5 patients (all of the 2D group) and included 5 recurrent laryngeal nerve palsies and 2 temporary tracheostomies for glottis oedema. There was no significant difference in the number of nodes retrieved. Conclusion Lymphadenectomy of the upper mediastinal nodes can be challenging and is associated with significant morbidity. In our experience, the use of SL tube ventilation facilitates the retraction of the trachea and the exposure of the area, and 3D thoracoscopy gives optimal magnified visualization of the recurrent nerves reducing the risk of damage.