Laparoscopic Mobilization Research Articles

Laparoscopic resection of a descending colon tumor with right-sided fixation of the sigmoid colon: a case report

BackgroundIntestinal malrotation is a condition in which the process of counterclockwise rotation and fixation to the peritoneum and retroperitoneum during fetal life is incomplete. In adults, it is generally asymptomatic and is often discovered incidentally. We report a case of laparoscopic partial resection of the descending colon for a tumor of the descending colon with a rare form of intestinal malrotation in which the inferior mesenteric artery ran symmetrically and the sigmoid colon was fixed to the dorsal cecum and right-sided retroperitoneum.Case presentationA 75-year-old man was referred to our department of internal medicine due to a positive fecal occult blood test. Lower endoscopy revealed a laterally spreading tumor in the descending colon, and endoscopic submucosal dissection was attempted; however, this procedure was difficult, and the patient was referred to our department for surgical treatment. Contrast-enhanced computed tomography revealed that the endoscopic clip was located in the descending colon on the right side, the inferior mesenteric artery was symmetrical, and the sigmoid colon was located on both the right and dorsal sides of the cecum. Laparoscopic ileocecum and sigmoid colon mobilization was performed from the left side of the patient. After the completion of sigmoid colon mobilization, which returned the sigmoid colon and descending colon to anatomical normalcy, laparoscopic partial resection of the descending colon was performed. Based on the results of a histopathological examination, a granular type of laterally spreading tumor was diagnosed. The patient was discharged uneventfully on postoperative day 8.ConclusionsDetailed preoperative imaging and surgical simulation are necessary for abdominal surgery involving intestinal malrotation.

A silicone disc for liver retraction in laparoscopic gastrectomy reduces the postoperative increase in the liver enzyme level.

To compare changes in liver enzyme levels on postoperative day 1 between patients with and without silicone disc (SD) use during liver retraction in laparoscopic gastrectomy for gastric cancer and laparoscopic gastric mobilization for esophageal cancer. This prospective randomized controlled phase II trial was conducted between June 30, 2020, and November 30, 2022, to investigate the benefits of using an SD with a Nathanson liver retractor (NLR) compared with those using an NLR in laparoscopic gastrectomy and gastric mobilization. The primary endpoint was the change in transaminase level on postoperative day 1. A total of 86 patients received randomized assignments and were included in the analysis, with 44 assigned to the SD (-) group and 42 to the SD (+) group. On postoperative day 1, the SD (+) group showed a significantly lower increase in the aspartate aminotransferase levels than the SD (-) group (SD [+], 94.4% vs. SD [-], 179.8%; p = 0.012). Similarly, the SD (+) group showed a significantly lower increase in alanine aminotransferase levels than the SD (-) group (SD [+], 71.6% vs. SD [-], 201.5%; p = 0.014). In laparoscopic gastrectomy, the use of an SD combined with an NLR appears to mitigate postoperative liver dysfunction.

Method for laparoscopic medial-lateral mobilization of the splenic flexure of the colon during anterior resection of the rectum

Method for laparoscopic medial-lateral mobilization of the splenic flexure of the colon during anterior resection of the rectum

The Sling Technique for Laparoscopic Liver Mobilization.

As liver surgery continues to evolve, be it open, laparoscopic or robotic, it remains a procedure that can deteriorate in the blink of an eye. Liver surgery in patients with hepatoma is further complicated, as the vast majority have significant fibrosis, if not cirrhosis. Thus, parenchymal sparing resection is increasingly necessary. Effective and safe intracorporeal mobilization of the liver is essential for minimal access parenchymal-sparing and conventional resection. This retrospective review of over 150 cases performed provides a hands-on approach to laparoscopic hepatic mobilization with the use of an inexpensive technique using a 1" packing tape to "Sling" the liver in-order to divide the ligaments holding the liver in place and optimally position the liver for parenchymal transection. Use of a 1" packing tape to "Sling" the liver intracorporeally is demonstrated to enable mobilization of the liver for tissue sparing non-anatomic, anatomic and major resections. Use of a 1" packing tape to "Sling" the liver intracorporeally can facilitate mobilization for resection. Surgeons hoping to master minimal access resection should also be well versed in the use of laparoscopic ultrasound and liver transplant "Piggyback" technique.

Bliss procedure for undescended ovaries

To highlight a novel surgical approach for the management of undescended ovaries in those presenting with infertility, to allow for potential transvaginal egg retrieval. The video demonstrates a novel surgical approach for mobilization and oophoropexy of undescended ovaries to allow for future transvaginal egg retrieval in the context of artificial reproductive technology (ART). Case report. Institutional Review Board approval is not required because this was not a human study. Patient consent was obtained for video footage. Hospital. We present a 26-year-old nulligravid woman with a unicornuate uterus, a high riding-right ovary, and an undescended left ovary with prior laparoscopic remnant uterine horn resection. Because of her 9 years of infertility and a prior unsuccessful ovarian mobilization and oophoropexy, she was referred for consideration of a repeat laparoscopic bilateral ovarian mobilization and oophoropexy. Surgical intervention for undescended ovaries. Postoperative ovarian location and postoperative pain. The patient reported minimal pain postoperatively at 6 weeks. Multiple follow-up imaging revealed both ovaries behind the uterus (antral follicle counts 15), with easy transvaginal access for future ART. Undescended ovary is uncommon and usually requires no treatment. However, intervention may be required in the context of infertility and ART, where transvaginal egg retrieval is impossible because of the location of the ovaries. This is the first educational video to our knowledge highlighting a novel surgical approach for the management of undescended ovaries.

Is laparoscope surgery feasible for upper gastrointestinal cancer patients with a history of abdominal surgery?

To investigate the feasibility of laparoscopic abdominal mobilization in patients with cancers of the esophagus or gastroesophageal junction who have a history of abdominal surgery. A total of 132 patients who underwent resection for cancers of the esophagus or gastroesophageal junction from August 2018 to March 2022 in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, were selected (66 patients with a history of abdominal surgery (observation group) and 66 patients without a history of abdominal surgery (control group)). All patients were treated with preoperative neoadjuvant therapy, based on the clinical stage. Thoracoscopic and laparoscopic resection was performed under general anesthesia. The intraoperative and postoperative conditions and surgical complications were compared between the two groups. No significant differences were found in baseline data between the observation group and the control group (p > 0.05). Laparoscopic abdominal mobilization was completed in both groups, and there were no significant differences between the two groups in the total operation time [(272.50 ± 86.45) min vs. (257.55 ± 67.96) min], abdominal mobilization time [(25.03 ± 9.82) min vs. (22.53 ± 3.88) min], blood loss [(119.09 ± 72.17) ml vs. (104.39 ± 43.82) ml], and postoperative time to first flatus [(3.44 ± 0.73) d vs. (3.29 ± 0.60) d] (p > 0.05). The abdominal mobilization time was longer in observation group than that in control group (p = 0.057). After excluding the patients (31/66) with a history of simple appendectomy from the observation group, the abdominal mobilization time was significantly longer in observation group than that in control group [(27.97 ± 12.16) min vs. (22.53 ± 3.88) min] (p < 0.05). There were significantly fewer dissected abdominal lymph nodes in the observation group than in the control group [(18.44 ± 10.87) vs. (23.09 ± 10.95), p < 0.05]. After excluding the patients (15/66) with a history of abdominal tumor surgery from the observation group, there was no significant difference in the number of dissected abdominal lymph nodes between the two groups [(20.62 ± 10.81) vs. (23.09 ± 10.95)] (p > 0.05).In addition, no postoperative complications, such as intestinal obstruction, abdominal infection and bleeding, occurred in either group. Patients with cancers of the esophagus or gastroesophageal junction who have a history of abdominal surgery are suitable for minimally invasive laparoscopic mobilization.

Application of overlap anastomosis in digestive tract reconstruction during minimally invasive Ivor-Lewis esophagectomy.

This study aims to assess the feasibility of the Overlap anastomosis technique in minimally invasive Ivor-Lewis esophagectomy. An accompanying video presentation elucidates our surgical procedures. A retrospective review of 46 patients diagnosed with middle and lower esophageal cancer was conducted. These patients underwent minimally invasive Ivor-Lewis esophagectomy with Overlap anastomosis between January 2019 and December 2020. A consistent team of surgeons performed all procedures. The initial phase involved laparoscopic stomach mobilization, intra-abdominal lymphadenectomies, and preparation of the tubular stomach. Subsequently, with the patient in the left decubitus position, thoracoscopy was used to dissect the esophagus, excise the diseased segment, and conduct mediastinal lymph node dissection. The final stage encompassed the intrathoracic gastroesophageal anastomosis using the Overlap method. All surgeries were completed without converting to an open approach, achieving complete resection. There were no operative fatalities, with an average surgery duration of 259.4min. Average statistics included intraoperative blood loss of 92.3ml, 16.2 lymph nodes dissected, and a postoperative hospital stay of 10.3days. Postoperative complications comprised three instances of hoarseness due to recurrent laryngeal nerve palsy, two cases of aspiration pneumonia, one occurrence of chylothorax, and one gastric emptying disorder. Anastomotic technique-related complications were minimal, with only one patient experiencing an anastomotic leak that resolved spontaneously and two patients facing anastomotic stenosis, which was subsequently alleviated. Our findings posit that the Overlap anastomosis method is safe and efficient for minimally invasive Ivor-Lewis esophagectomy, marked by a notably low rate of anastomosis-related complications. Further evaluation of its long-term implications remains necessary.

Application of single-port laparoscopic retrograde gastric mobilization during McKeown esophagectomy for esophageal cancer.

As a novel alternative to the conventional minimally invasive esophagectomy (MIE) to treat esophageal cancer, single-port laparoscopic retrograde three-step gastric mobilization (SLRM) for esophageal reconstruction during MIE to treat esophageal cancer was attempted in our department. The aim of the present study was to explore the preliminary clinical outcomes and feasibility of this innovative surgery. From March 2020 to November 2021, patients undergoing SLRM combined with four-port thoracoscopic McKeown esophagectomy for their esophageal cancers were reviewed. Gastric mobilization with abdominal lymph node dissection was performed through SLRM. The clinical characteristics and short-term outcomes were analyzed retrospectively. A total of 120 patients underwent R0 resection without conversion to open surgery. The mean times needed for the thoracic part, abdominal part, and total operation were 43 ± 6 min, 60 ± 18 min, and 230 ± 20 min, respectively. The numbers of mediastinal and abdominal lymph nodes harvested were 13.2 ± 2.7 and 10.2 ± 2.5, respectively. Postoperative pneumonia was encountered in 10 (8.3%) patients. Anastomotic leakage occurred in 3 (2.5%) cases. Temporary vocal cord paralysis was reported in 20 (16.6%) cases. The mean length of hospital stay was 8.5 ± 4.6 days. The SLRM is a technically feasible and safe treatment for patients with esophageal cancer. It can be considered an alternative method for patients, especially for the ones with obesity and gastric distension.

The first experience of fluorescent angiography with indocyanine green in primary esophagoplasty with gastric conduit in patients with malignant tumors of the esophagus

To evaluate the possibilities of intraoperative indocyanine green fluorescein angiography (ICG technology) in primary esophagoplasty by gastric conduit in patients with malignant tumors of the esophagus. The study included 74 patients. Depending on the localization of the tumor in the esophagus, a Lewis-type or McKeown-type operation was performed. The retrospective group (surgery without the use of ICG technology) included 53 patients who underwent surgery from 2015 to 2020 years.The prospective group (surgery with the use ICG technology) included 21 patients operated on from 2021 to 2023 years. ICG technology was used to assess microcirculation in the gastric conduit during esophagoplasty, as well as to identify the right gastroepiploic artery. The ICG fluorescein angiography technique for assessing microcirculation in the gastric conduit was a simple and easily reproducible procedure. Perfusion of the gastric conduit was regarded as satisfactory in 16 (76%) cases, unsatisfactory in 5 (24%) cases, which required resection of the distal part of the conduit. All cases of poor perfusion were in patients with narrow gastric conduit and neck anastomosis location (McKeown-type operation). Anastomotic leakages occurred in 8 (15%) patients in the retrospective group, 4 (19%) patients in the prospective group (p>0.05). In 4 out of 5 cases of poor gastric conduit perfusion, anastomotic leaks occurred. Immediate postoperative results in the compared groups were also comparable. The use of ICG technology in 5 (45%) cases out of 11, when laparoscopic mobilization of the stomach was performed, helped to visualize the right gastroepiploic artery, which is the main source of blood supply to the formed gastric conduit. The use of ICG technology in 3 patients with a compromised gastrostomy stomach demonstrated the absence of significant microcirculation disorders in the stomach wall. The first experience of using fluorescein angiography with ICG in primary esophagoplasty by gastric conduit in patients with malignant tumors of the esophagus demonstrated the safety, simplicity and availability of this technique. An objective assessment of the effectiveness of the application of ICG technology requires the accumulation of experience.

OGC P43 Oncological outcomes following the introduction of laparoscopic gastric mobilisation during Ivor Lewis Oesophagogastrectomy within a regional Scottish centre

Abstract Background Ivor Lewis Oesophagogastrectomy (ILO) is a potentially curative but highly morbid surgery. Minimally invasive techniques by comparison have demonstrated improved post-operative outcomes for patients. Hybrid laparoscopic gastric mobilisation (LGM) combined with an open right thoracotomy was introduced in our centre in 2019. This study assessed oncological outcomes between ILO with LGM and a fully open ILO, following this local change in operative technique. Methods This was a retrospective study of patients undergoing ILO at a single tertiary unit over a 5-year period (2017–2021). All patients undergoing open ILO were compared with those who had ILO with LGM. Resected lymph node count was used as a marker for oncological outcomes and median length of hospital stay a marker for post-operative outcomes. Results During the study period, 42 patients had open ILO and 32 had ILO with LGM. Patient demographics were similar between groups, with the majority receiving neoadjuvant chemotherapy (Open ILO 92.9% vs LGM 96.9%, p=0.629). Following local introduction of LGM in 2019, it immediately became the predominant method of gastric mobilisation during ILO (58% cases in 2019; 100% cases in 2020; 73% cases in 2021). Median total lymph node count resected was similar between LGM 17(15–25) vs open ILO 18 (16–24), p=0.643. Overall, length of stay was shorter in those having LGM compared to open (16 (11–21) vs 18 (11–36)), although this did not reach statistical significance (p=0.129). Conclusions Introduction of a hybrid minimally invasive technique for oesophagogastrectomy within our regional centre, has been associated with similar oncological outcomes to the traditional open approach. Further evaluation is required to ascertain the potential patient benefits of a LGM on post-operative outcomes within our patient cohort.

Utility of single-port laparoscopic retrograde gastric mobilization during McKeown esophagectomy for esophageal cancer: a 2-year experience with 120 cases in a single institution

As a novel alternative to the conventional minimally invasive esophagectomy (MIE), more minimally invasive single-port laparoscopic retrograde 3-step gastric mobilization (SLRM) for esophageal reconstruction during MIE to treat esophageal cancer was attempted by our department. This study explored the preliminary clinical outcomes and feasibility of this innovative surgery. The data of 120 patients who had undergone SLRM combined with 4-port thoracoscopic McKeown esophagectomy for their esophageal cancers from March 2020 to November 2021 were reviewed. Gastric mobilization with abdominal lymph node dissection was performed via SLRM. The clinical characteristics and short-term outcomes were retrospectively analyzed. The data of operating time, blood loss, harvested lymph nodes, postoperative hospital stay and complications are presented as the mean and standard deviation. A total of 120 patients underwent R0 resection without conversion to open surgery. The mean times for the thoracic procedure, abdominal procedure, and total operation were 43±6, 60±18, and 195±20 min, respectively. The numbers of mediastinal and abdominal lymph nodes harvested were 13.2±2.7, and 10.2±2.5, respectively. Postoperative pneumonia occurred in 10 patients (8.3%). Anastomotic leakage occurred in 3 patients (2.5%). Temporary vocal cord paralysis was reported in 20 patients (16.6%). The mean length of hospital stay was 8.5±4.6 days. SLRM is a technically feasible and safe treatment for patients with esophageal cancer. It can be considered an alternative method for patients, especially those with obesity and gastric distension.

614. SIGNIFICANCE OF LAPAROSCOPIC SURGERY IN OPEN THORACOTOMY ESOPHAGECTOMY

Abstract The usefulness of laparoscopic surgery in esophageal cancer surgery has been reported in the MIRO trial, but there are few reports of laparoscopic surgery in esophageal subtotal resection, which is the standard surgical procedure in Japan. Furthermore, chest procedures are often performed by thoracoscopic surgery, making it difficult to evaluate laparoscopic operations. This time, we retrospectively examined the usefulness of laparoscopic procedure in right thoracotomy surgery. From 2007 to 2019, 135 patients with esophageal cancer who underwent thoracotomy and subtotal esophagectomy and were reconstructed by gastric tube (post-sternal route, cervical anastomosis) were included. In the laparoscopic group (Lap group), gastric mobilization and perigastric lymph node dissection were performed under 5-port. The stomach was pulled out of the abdominal cavity with a small laparotomy of 4-5 cm to prepare a gastric tube. In the case of open surgery (Open group), epigastric midline incision (15-20 cm) was performed up to the navel. There were 67 cases in the Lap group and 68 cases in the Open group. There was no difference in thoracotomy time between the two groups. In the Lap group, the amount of bleeding was significantly less than in the Open group (289g vs 376g), and the operation time was longer. Lung complications of Clavien-Dindo classification Grade 2 or higher were significantly less in the Lap group (10% vs 24%). There was no difference between the two groups in anastomotic insufficiency and recurrent laryngeal nerve palsy. The number of dissected lymph nodes was significantly higher in the Lap group. Laparoscopic abdominal manipulation in open esophageal cancer surgery was useful in reducing pulmonary complications.

Laparoscopic approach for malignant retrorectal tumour: Better vision and lesser morbidity.

The retrorectal tumours are removed by open approaches according to the type, location and size of the lesion. Malignant tumours are mostly operated by open approach owing to the fear of spillage and inability to obtain safe oncological margin. We present our recent experience of laparoscopy for a malignant retrorectal tumour. An 11 cm pre-sacral mass causing erosion of sacrum was operated with a combined approach. Transsacral approach followed laparoscopic mobilisation with the patient in prone jackknife position. Wide excision with sacrectomy was done with adequate margin. Post-operative histopathology showed dedifferentiated chordoma for which adjuvant radiotherapy was given. Laparoscopic approach provides a feasible and oncological safe alternative to the conventional approaches, especially in malignant tumour with advantages of better visualisation, minimal operative morbidity, lesser post-operative pain and shorter hospital stay. However, the surgical approach should be tailored to each patient according to patient factors, tumour characteristics and surgeon's expertise.

Pancreatic injuries following laparoscopic splenic flexure mobilization.

To call awareness to pancreatic injury occurring following laparoscopic splenic flexure mobilization (LSFM) and to discuss the mechanisms which led to such an injury. Retrospective review of patients who underwent LSFM as part of their colectomy procedure and sustained pancreatic injuries at a colorectal surgery referral center during 2014-2021. Of 1022 (0.6%) LSFM performed during the study period, six (0.6%) patients were identified in which clinically significant injuries to the pancreas occurred. Two patients had partial transection of the tail of the pancreas and underwent laparoscopic distal pancreatectomy during the index operation. Three patients developed a post-operative pancreatic fistula after their pancreatic injury went undiagnosed during surgery and required percutaneous drainage, one of whom eventually required a distal pancreatectomy for a persistent pancreatic fistula. Another patient developed a peripancreatic fluid collection which resolved with conservative treatment. Pancreatic injury is rare and a potentially major complication of LSFM. Anatomical misperception, retroperitoneal bleeding, a large bulky splenic flexure tumor, and a "difficult flexure" were recognized as possible mechanisms of such injury.

Ten-year experience with laparoscopic pedicled omental flap for cerebral revascularization in patients with Moyamoya disease

BackgroundThe omental flap has numerous extraperitoneal applications in reconstruction and revascularization given its favorable immunologic and angiogenic properties. In patients with Moyamoya disease, cerebral revascularization using a pedicled omental flap has proven to be a viable option following direct revascularization procedures. Historically, harvesting omentum involved laparotomy with the associated risk of complications; herein we describe outcomes from a 10-year experience of laparoscopic harvesting of pedicled omental flap for cerebral revascularization in Moyamoya patients. MethodsA retrospective chart review was performed of all patients with Moyamoya disease who underwent laparoscopic omental cerebral transposition between 2011 and 2021. Intraoperative and postoperative complications, length of stay (LOS), and outcomes at follow-up were analyzed. ResultsTwenty-one patients underwent the procedure during the study period. Three intraoperative complications occurred (one segmental transverse colectomy for mesenteric injury, one converted to omental free flap, and one requiring micro anastomosis). Average overall LOS was 6 ± 6 days, with 3 ± 3.5 days in the ICU (mean±SD). Following discharge, complications included epigastric incisional hernia at the graft fascial exit site, recurrent neck pain at subcutaneous tunneling site, and partial scalp necrosis. One patient required subsequent direct bypass seven months after the initial procedure owing to the progression of the disease. All other patients had partial or complete resolution of symptoms. ConclusionOur retrospective observational study indicates that laparoscopic pedicled omental flap mobilization and transposition is a safe and effective method of indirect cerebral revascularization in patients with Moyamoya disease. Level of evidenceN/A.

EP.FRI.874 Laparoscopic Assisted Submucosal Excision of an Intussuscepted Colonic Lipoma through a Colotomy; A New Technique

Abstract Lipomas are the most common non-epithelial tumours of the colon. Nevertheless, symptomatic colonic lipomas are a rare entity in adults. Intussusception is the commonest complication of submucosal lipomas and often presents with absent, non-specific or intermittent symptoms, hence the diagnosis is challenging. In non-emergency situations, most patients undergo computed tomography scan as well as endoscopic evaluation of the colon prior to any surgical intervention. While successful endoscopic excision of lipomas has been reported, segmental resection of the colon is most commonly practiced. To the best of our knowledge, this is the first report of laparoscopic assisted submucosal excision of an intussuscepting colonic lipoma through a colotomy. We present the case of a young female patient with few weeks history of intermittent abdominal pain associated with nausea. She had previously undergone various investigations including colonoscopy and was awaiting an elective left hemicolectomy. She presented to our Emergency department with subacute large bowel obstruction. A CT scan confirmed the diagnosis of colo-colic intussusception due to a large descending colon lipoma. The patient underwent a laparoscopic assisted procedure - following laparoscopic colonic mobilisation, submucosal excision of the large lipoma was performed through a colotomy placed through the taenia on the opposite wall. The mucosal defect and colotomy were closed following the excision. The patient recovery was uneventful and histopathology of the specimen confirmed the diagnosis.

The Impact of Infectious Complications after Esophagectomy for Esophageal Cancer on Cancer Prognosis and Treatment Strategy.

Despite advances in the perioperative management of esophagectomy, it is still a highly invasive procedure for esophageal cancer and is associated with severe postoperative complications. The two major postoperative infectious complications after esophagectomy are pulmonary complications and anastomotic leakage. We previously reported that postoperative infectious complications after esophagectomy adversely affect long-term survival significantly in a single institution and meta-analysis. Additionally, we reviewed the mechanisms of proinflammatory cytokines, such as C-X-C motif ligand 8 (CXCL8) and its cognate receptor, C-X-C chemokine receptor 2 (CXCR2), in contributing to tumorigenesis and tumor progression. Moreover, we previously reported that introducing minimally invasive esophagectomy, including robot assistance, laparoscopic gastric mobilization, and multidisciplinary team management, significantly reduced postoperative infectious complications after esophagectomy. Further, this review also suggests future treatment strategies for esophageal cancer, considering the adverse effect of postoperative infectious complications after esophagectomy.

201 POSTOPERATIVE OUTCOMES OF MINIMALLY INVASIVE ESOPHAGEAL SURGERY FOR ESOPHAGEAL CANCER IN A SINGLE CENTER

Abstract The aim if this study is to evaluate the safety and feasibility of minimally invasive esophageal surgery for esophageal cancer in a small volume center. Methods The medical records of patients who had undergone minimally invasive esophageal surgery (VATS Ivor Lewis operation with laparoscopic gastric mobilization) for their esophageal cancer between June 2017 and September 2019 in our institute were reviewed retrospectively. Perioperative outcomes including postoperative morbidities and mortalities were evaluated. Results A total of 31 patients were included in this study. The mean operation time for laparoscopic gastric mobilization were 111.3 minutes and those for VATS Ivor Lewis operation were 235.5 minutes. Seven patients underwent Neoadjuvant therapy. Half of the cases were stage I, however, operation could be performed in more advanced cases. There was no conversion to open procedure. Overall complication rates were 49.1%, and complication more than Grade III in Clavien-Dindo classification were 16.1%. Overall postoperative morality was 6.4%. Two patients died at 42 and 47 postoperative days due to acute respiratory failure, and one patient. Conclusion Minimally invasive esophageal surgery for esophageal cancer could be feasibly performed even in advanced cases. Postoperative pneumonia should be carefully managed to prevent postoperative mortality.

Effect of the postural transition in minimally invasive esophagectomy: a propensity score matching analysis.

The advantages of prone position in minimally invasive esophagectomy have not been well studied. This study aimed to investigate the safety and feasibility of a transition from the left lateral decubitus position to the prone position for thoracic procedures in minimally invasive esophagectomy. We retrospectively analyzed patients with thoracic esophageal carcinomas who underwent thoracoscopic esophagectomy and laparoscopic gastric mobilization between January 2015 and December 2019. The left decubitus and prone positions were analyzed using propensity score-matched pairs for the baseline characteristics, morbidity, and survival. A total of 114 consecutive patients were included in this study; 90 (78.9%) were male and the median age was 67.2years old. Of these patients, 39 and 75 underwent left decubitus and prone esophagectomy, respectively. Prone esophagectomy was associated with a lower incidence of pneumonia than that performed in the decubitus position (12.5% vs. 37.5%, p = 0.0187). With respect to the long-term outcomes, there were no significant differences between the 2 groups. The 4-year overall and relapse-free survival rates for prone and decubitus esophagectomy were 73.8% and 73.2%, and 84.4% and 71.8%, respectively (p = 0.9899 and 0.6751, respectively). Prone esophagectomy yielded a shorter operative time (total: 528 [485-579] min vs. 581 [555-610] min, p < 0.0022; thoracic section: 243 [229-271] min vs. 292 [274-309] min, p < 0.0001), less bleeding in the thoracic procedures (0 [0-10] mL vs. 70 [20-138] mL, p < 0.0001), a shorter length of postoperative hospital stay (19 [15-23] vs. 30 [21-46] days, p = 0.0002), and a lower total hospital charge (30,046 [28,175-32,660] US dollars vs. 36,396 [31,533-41,180] US dollars, p < 0.0001). Transition into the prone position in minimally invasive esophagectomy is feasible with adequate postoperative and oncological safety and economical in esophageal cancer surgery.

Totally Robotic Esophagectomy

Totally robotic esophagectomy is performed using a robotic technique without additional thoracoscopy or laparoscopy. However, most robotic esophagectomies are currently performed in a hybrid form combining robotic and other endoscopic techniques. Laparoscopic stomach mobilization and thoracoscopic esophagogastric anastomosis are commonly used methods in robotic esophagectomy. In this paper, totally robotic esophagectomy without thoracoscopic or laparoscopic assistance is presented.