Skip to main content
SpringerLink
Log in

Minimally invasive esophagectomy

Minimal invasive Ösophagektomie

  • Main Topic
  • Published:
European Surgery Aims and scope Submit manuscript

Zusammenfassung

GRUNDLAGEN: Die konventionelle Ösophagektomie ist technisch aufwendig und ist mit einer entsprechenden Morbidität und Mortalität verbunden. METHODIK: Kritische Beurteilung der minimal invasiven Ösophagektomie. ERGEBNISSE: Die minimal invasive Ösophagektomie ist technisch anspruchsvoll, kann aber dazu beitragen, postoperative Komplikationen zu minimieren und die postoperative Lebensqualität zu verbessern. Die größte publizierte Serie zeigte eine Mortalität von 1,4 %, 11 % Anastomosendehiszenzrate und eine Verkürzung des Spitalsaufenthaltes nach minimal invasiver Ösophagektomie. Die Erfahrungen aus Pittsburg haben zu technischen Verbesserungen geführt, wie die Anlage eines engeren Magenpouches, Durchführung der Ivor-Lewis-Anastomose und eine radikalere Lymphknoten Resektion. SCHLUSSFOLGERUNGEN: In dieser Arbeit werden Hintergrund, Technik, Probleme und die Zukunft der minimal invasiven Ösophagektomie kritisch beleuchtet.

Summary

BACKGROUND: Esophagectomy can be a formidable operation even in experienced hands. METHODS: Critical appraisal towards minimal invasive esophagectomy. RESULTS: The complications are often lethal. Patients developing postoperative pneumonia after open esophagectomy have up to a 20% mortality rate. In an effort to reduce the morbidity and mortality of open esophagectomy, minimally invasive techniques have been developed. This is a challenging procedure technically, but offers the chance to lessen complications and improve survival. The learning curve is steep. Proper port placement, patient positioning, and facile use of mechanical staplers is mandatory. However, the largest published series to date of minimally invasive esophagectomies [MIE] showed a 1.4% mortality rate, an 11% anastamotic leak rate, and lowered lengths of stay. The evolving Pittsburgh experience has resulted in technical modifications like narrower gastric pouches, Ivor Lewis type anastamoses, and more complete lymph node resection. CONCLUSIONS: This paper discusses the background, techniques, challenges, and future direction for using this technique to treat esophageal disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

References

  • Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R (1991) Laparoscopic Nissen fundoplication: preliminary report. Surg Endosc 3: 138–143

    Google Scholar 

  • Ackroyd R, Watson DI, Majeed AW, Troy G, Treacy PJ, Stoddard CJ (2004) Randomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux disease. Br J Surg 91: 975–982

    Article  PubMed  CAS  Google Scholar 

  • DeMeester TR, Bonavina L, Albertucci M (1986) Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg 204: 9–20

    Article  PubMed  CAS  Google Scholar 

  • Hunter J, Trus T, Branum G, Waring J, Wood C (1996) Physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg 223: 673–685

    Article  PubMed  CAS  Google Scholar 

  • Luketich JD, Fernando HC, Christie NA, Buenaventura PO, Keenan RJ, Ikramuddin S, Schauer PR (2001) Outcomes after minimally invasive esophagomyotomy. Ann Thorac Surg 72: 1909–1912

    Article  PubMed  CAS  Google Scholar 

  • Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, Diener U, Eubanks TR, Way LW (1999) Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 230: 587–593

    Article  PubMed  CAS  Google Scholar 

  • Khajanchee Y, Kanneganti S, Leatherwood A, Hansen P, Swanstrom L (2005) Laparoscopic Heller myotomy with Toupet fundoplication: outcomes predictors in 121 consecutive patients. Arch Surg 140: 827–833

    Article  PubMed  Google Scholar 

  • Patti MG, Fisichella PM, Perretta S, Galvani C, Gorodner MV, Robinson T, Way LW (2003) Impact of minimally invasive surgery on the treatment of achalsia: a decade of change. J Am Coll Surg 196: 698–705

    Article  PubMed  Google Scholar 

  • Millikan KW, Silverstein J, Hart V, Blair K, Bines S, Roberts J, Doolas A (1999) A 15-year review of esophagectomy for carcinoma of the esophagus and cardia. J Am Coll Surg 118: 328–332

    Google Scholar 

  • Atkins BZ, Shah AS, Hutcheson KA, Mangum JH, Pappas TN, Harpole DH Jr, D'Amico TA (2004) Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 78: 1170–1176

    Article  PubMed  Google Scholar 

  • Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238: 486–495

    PubMed  Google Scholar 

  • Stahl M, Stuschke M, Lehmann N, Meyer HJ, Walz MK, Seeber S, Klump B, Budach W, Teichmann R, Schmitt M, Schmitt G, Franke C, Wilke H (2005) Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 23: 2310–2317

    Article  PubMed  Google Scholar 

  • Chiu PW, Chan AC, Leung SF, Leong HT, Kwong KH, Li MK, Au-Yeung AC, Chung SC, Ng EK (2005) Multicenter prospective randomized trial comparing standard esophagectomy with chemoradiotherapy for treatment of squamous esophageal cancer: early results from the Chinese University Research Group for Esophageal Cancer (CURE). J Gastrointest Surg 9: 794–802

    Article  PubMed  Google Scholar 

  • National Comprehensive Cancer Network Guidelines (2003) Version 1: http://www.nccn.org

  • Collard JM, Lengele B, Otte JB, Kestens PJ (1993) En bloc and standard esophagectomies by thoracoscopy. Ann Thorac Surg 56: 675–679

    Article  PubMed  CAS  Google Scholar 

  • Akaishi T, Kaneda I, Higuchi N, Kuriya Y, Kuramoto J, Toyoda T, Wakabayashi A (1996) Thoracoscopic en bloc total esophagectomy with radical mediastinal lymphadenectomy. J Thorac Cardiovasc Surg 112: 1533–1540

    Article  PubMed  CAS  Google Scholar 

  • Robertson GS, Lloyd DM, Wicks AC, Veitch PS (1996) No obvious advantages for thoracoscopic two-stage oesophagectomy. Br J Surg 83: 675–678

    Article  PubMed  CAS  Google Scholar 

  • DePaula AL, Hashiba K, Ferreira EA, de Paula RA, Grecco E (1995) Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc 5: 1–5

    PubMed  CAS  Google Scholar 

  • Swanstrom LL, Hansen P (1997) Laparoscopic total esophagectomy. Arch Surg 132: 943–947

    PubMed  CAS  Google Scholar 

  • Cherian V, Divatia JV, Kulkarni A, Dasgupta D (2001) Cardiomediastinal tamponade and shock following three-stage transthoracic esophagectomy. J Postgrad Med 47: 185–187

    PubMed  CAS  Google Scholar 

  • Nguyen NT, Follette DM, Wolfe BM, Schneider PD, Roberts P, Goodnight JE Jr (2000) Comparison of minimally-invasive esophagectomy with transthoracic and transhiatal esophagectomy. Arch Surg 135: 920–955

    Article  PubMed  CAS  Google Scholar 

  • Narumiya K, Nakamura T, Ide H, Takasaki K (2005) Comparison of extended esophagectomy through mini-thoracotomy/laparotomy with conventional thoracotomy/laparotomy for esophageal cancer. Jpn J Thorac Cardiovasc Surg 53: 413–419

    Article  PubMed  Google Scholar 

  • Nguyen N, Roberts P, Follette D, Rivers R, Wolfe B (2003) Thoracoscopic and laparoscopic esophagectomy for benign and malignant disease: lessons learned from 46 consecutive procedures. J Am Coll Surg 197: 902–913

    Article  PubMed  Google Scholar 

  • Bizekis C, Kent MS, Luketich JD, Buenaventura PO, Landreneau RJ, Schuchert MJ, Alvelo-Rivera M (2006) Initial experience with minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg 82: 402–406

    Article  PubMed  Google Scholar 

  • Cushieri A, Shimi S, Banting S (1992) Endoscopic esophagectomy through a right thoracoscopic approach. JR Coll Surg Edinb 37: 7–11

    Google Scholar 

  • Palanivelu C, Prakash A, Senthilkumar R, Senthilnathan P, Parthasarathi R, Rajan PS, Venkatachlam S (2006) Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position. An experience of 130 patients. J Am Coll Surg 203: 7–16

    Article  PubMed  Google Scholar 

  • Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138: 777–784

    Article  PubMed  Google Scholar 

  • Bodner J, Wykypiel H, Wetscher G, Schmid T (2004) First experience with the da Vinci trademark operating robot in thoracic surgery. Eur J Cardiothorac Surg 25: 844–851

    Article  PubMed  CAS  Google Scholar 

  • Melvin WS, Needleman BJ, Krause KR, Schneider C, Wolf RK, Michler RE, Ellison EC (2002) Computer-enhanced robotic telesurgery: initial experience in foregut surgery. Surg Endosc 16: 1790–1792

    Article  PubMed  CAS  Google Scholar 

  • Horgan S, Berger R, Elli E, Espat N (2003) Robotic-assisted minimally-invasive transhiatal esophagectomy. Am Surg 69: 624–669

    PubMed  Google Scholar 

  • Jacobsen G, Espat N, Berger R, et al (2004) A single institution experience with robotically assisted transhiatal total esophagectomy. SAGES. Scientific and Postgraduate Courses March 31–April 3, 2004. Denver, CO, US

  • Watson DI, Jamieson GG, Devitt PG (2000) Endoscopic cervico-thoracoabdominal esophagectomy. J Am Coll Surg 193: 372–378

    Article  Google Scholar 

  • Gossot D, Cattan P, Fritsch S, Halimi B, Sarfati E, Celerier M (1995) Can the morbidity of esophagectomy be reduced by the thoracoscopic approach? Surg Endosc 9: 1113–1115

    Article  PubMed  CAS  Google Scholar 

  • Jagot P, Sauvanet A, Berthoux L, Belghiti J (1996) Laparoscopic mobilization of the stomach for oesophageal replacement. Br J Surg 83: 540–542

    Article  PubMed  CAS  Google Scholar 

  • Liu HP, Chang CH, Lin PJ, Chang JP (1995) Video-assisted endoscopic esophagectomy with stapled intrathoracic esophagogastric anastomosis. World J Surg 19: 745–747

    Article  PubMed  CAS  Google Scholar 

  • Peracchia A, Rosati R, Fumagalli U, Bona S, Chella B (1997) Thoracoscopic esophagectomy: Are there benefits? Sem Surg Oncol 13: 259–262

    Article  CAS  Google Scholar 

  • Law S, Fok M, Chu KM, Wong J (1997) Thoracoscopic esophagectomy for esophageal cancer. Surgery 122: 8–14

    Article  PubMed  CAS  Google Scholar 

  • Kawahara K, Maekawa T, Okabayashi K, Hideshima T, Shiraishi T, Yoshinaga Y, Shirakusa T (1999) Video-assisted thoracoscopic esophagectomy for esophageal cancer. Surg Endosc 13: 218–223

    Article  PubMed  CAS  Google Scholar 

  • Smithers BM, Gotley DC, McEwan D, Martin I, Bessell J, Doyle L (2001) Thoracoscopic mobilization of the esophagus: a six year experience. Surg Endosc 15: 176–182

    Article  PubMed  CAS  Google Scholar 

  • Osugi H, Takemura M, Higashino M, Takada N, Lee S, Ueno M, Tanaka Y, Fukuhara K, Hashimoto Y, Fujiwara Y, Kinoshita H (2003) Learning curve of video-assisted thoracoscopic esophagectomy and extensive lymphadenectomy for squamous cell cancer of the thoracic esophagus and results. Surg Endosc 17: 515–519

    Article  PubMed  CAS  Google Scholar 

  • Mathisen DJ, Grillo HC, Wilkins EW Jr, Moncure AC, Hilgenberg AD (1988) Transthoracic esophagectomy: a safe approach to carcinoma of the esophagus. Ann Thorac Surg 45: 137–143

    Article  PubMed  CAS  Google Scholar 

  • Lerut T, De Leyn P, Coosemans W, Van Raemdonck D, Scheys I, LeSaffre E (1992) Surgical strategies in esophageal carcinoma with emphasis on radical lymphadenectomy. Ann Surg 216: 583–590

    Article  PubMed  CAS  Google Scholar 

  • Orringer MB, Marshall B, Iannettoni MD (1999) Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 230: 392–403

    Article  PubMed  CAS  Google Scholar 

  • Swanson SJ, Batirel HF, Bueno R, Jaklitsch MT, Lukanich JM, Allred E, Mentzer SJ, Sugarbaker DJ (2001) Transthoracic esophagectomy with radical mediastinal and abdominal lymph node dissection and cervical esophagogastrostomy for esophageal carcinoma. Ann Thorac Surg 72: 1918–1925

    Article  PubMed  CAS  Google Scholar 

  • Bailey SH, Bull DA, Harpole DH, Rentz JJ, Neumayer LA, Pappas TN, Daley J, Henderson WG, Krasnicka B, Khuri SF (2003) Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg 75: 217–222

    Article  PubMed  Google Scholar 

  • Rizk NP, Bach PB, Schrag D, Bains MS, Turnbull AD, Karpeh M, Brennan MF, Rusch VW (2004) The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coll Surg 198: 42–50

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, St. Catharines General Hospital, Niagara Health System, St. Catharines, Ontario, Canada

    A. S. Ashrafi

  2. The Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A.

    S. B. Keeley, M. Shende & J. D. Luketich

Authors
  1. A. S. Ashrafi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. B. Keeley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Shende
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. D. Luketich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. D. Luketich.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ashrafi, A., Keeley, S., Shende, M. et al. Minimally invasive esophagectomy. Eur Surg 39, 141–150 (2007). https://doi.org/10.1007/s10353-007-0332-6

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10353-007-0332-6

Schlüsselwörter

Keywords

Search

Navigation