Simplifying minimally invasive transhiatal esophagectomy with the inversion approach: Lessons learned from the first 20 cases

Blair A. Jobe, Charles Y. Kim, Renee C. Minjarez, Robert O'Rourke, Eugene Y. Chang, John Hunter

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Hypothesis: The laparoscopic transhiatal esophagectomy can be simplified and performed safely and effectively by using a novel esophageal inversion technique. Design: Case series describing technique, initial experience, and learning curve with laparoscopic inversion esophagectomy. Setting: Tertiary care university hospital and veteran's hospital. Patients: Twenty consecutive patients with highgrade dysplasia (n = 16) and esophageal adenocarcinoma (n = 4). Intervention: Laparoscopic inversion esophagectomy, a totally laparoscopic approach to transhiatal esophagectomy that incorporates distal to proximal inversion to improve mediastinal exposure and ease of dissection. Main Outcome Measures: Perioperative end points and complications, compared between the first and second groups of 10 patients. Results: There were 19 men and 1 woman. Median operative time was 448 minutes. Median blood loss was 175 cm3. Median intensive care unit stay was 4 days, and median total hospital stay was 9 days. Overall anastomotic leak rate was 20%. Five patients developed an anastomotic stricture, all successfully managed with endoscopic dilation. There were 2 recurrent laryngeal nerve injuries, which resolved. There was no intraoperative or 30-day mortality. Between the first 10 consecutive cases and last 10 procedures, the incidence of anastomotic leak and stricture formation decreased from 30% to 10% and 40% to 10%, respectively. During this period, the number of lymph nodes harvested increased 9-fold, and duration of intensive care unit stay decreased from 8.00 to 2.50 days. Conclusions: Laparoscopic inversion esophagectomy is a safe procedure. The learning curve for the inversion approach is approximately 10 operations in the hands of esophageal surgeons with advanced laparoscopic expertise.

Original languageEnglish (US)
Pages (from-to)857-865
Number of pages9
JournalArchives of Surgery
Volume141
Issue number9
DOIs
StatePublished - 2006

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Esophagectomy
Anastomotic Leak
Learning Curve
Intensive Care Units
Pathologic Constriction
Recurrent Laryngeal Nerve Injuries
Veterans Hospitals
Tertiary Healthcare
Operative Time
Dissection
Dilatation
Length of Stay
Adenocarcinoma
Lymph Nodes
Outcome Assessment (Health Care)
Mortality
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Simplifying minimally invasive transhiatal esophagectomy with the inversion approach : Lessons learned from the first 20 cases. / Jobe, Blair A.; Kim, Charles Y.; Minjarez, Renee C.; O'Rourke, Robert; Chang, Eugene Y.; Hunter, John.

In: Archives of Surgery, Vol. 141, No. 9, 2006, p. 857-865.

Research output: Contribution to journalArticle

Jobe, Blair A. ; Kim, Charles Y. ; Minjarez, Renee C. ; O'Rourke, Robert ; Chang, Eugene Y. ; Hunter, John. / Simplifying minimally invasive transhiatal esophagectomy with the inversion approach : Lessons learned from the first 20 cases. In: Archives of Surgery. 2006 ; Vol. 141, No. 9. pp. 857-865.
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