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 language | English (US) |
|---|---|
| Pages (from-to) | 857-865 |
| Number of pages | 9 |
| Journal | Archives of Surgery |
| Volume | 141 |
| Issue number | 9 |
| DOIs | |
| State | Published - 2006 |
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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 journal › Article
}
TY - JOUR
T1 - Simplifying minimally invasive transhiatal esophagectomy with the inversion approach
T2 - Lessons learned from the first 20 cases
AU - Jobe, Blair A.
AU - Kim, Charles Y.
AU - Minjarez, Renee C.
AU - O'Rourke, Robert
AU - Chang, Eugene Y.
AU - Hunter, John
PY - 2006
Y1 - 2006
N2 - 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.
AB - 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.
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U2 - 10.1001/archsurg.141.9.857
DO - 10.1001/archsurg.141.9.857
M3 - Article
C2 - 16983029
AN - SCOPUS:33748775454
VL - 141
SP - 857
EP - 865
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 9
ER -