Surgical Endoscopy

, Volume 26, Issue 8, pp 2095–2103 | Cite as

Thoracoscopic esophagectomy in the prone position

  • Omar A. Jarral
  • Sanjay Purkayastha
  • Thanos Athanasiou
  • Ara Darzi
  • George B. Hanna
  • Emmanouil Zacharakis
Review

Abstract

Background

Minimally invasive esophageal surgery has arisen in an attempt to reduce the significant complications associated with esophagectomy. Despite proposed technical and physiological advantages, the prone position technique has not been widely adopted. This article reviews the current status of prone thoracoscopic esophagectomy.

Methods

A systematic literature search was performed to identify all published clinical studies related to prone esophagectomy. Medline, EMBASE and Google Scholar were searched using the keywords “prone,” “thoracoscopic,” and “esophagectomy” to identify articles published between January 1994 and September 2010. A critical review of these studies is given, and where appropriate the technique is compared to the more traditional minimally invasive technique utilising the left lateral decubitus position.

Results

Twelve articles reporting the outcomes following prone thoracoscopic oesophagectomy were tabulated. These studies were all non-randomised single-centre prospective or retrospective studies of which four compared the technique to traditional minimally invasive surgery. Although prone esophagectomy is demonstrated as being both feasible and safe, there is no convincing evidence that it is superior to other forms of esophageal surgery. Most authors comment that the prone position is associated with superior surgical ergonomics and theoretically offers a number of physiological benefits.

Conclusion

The ideal approach within minimally invasive esophageal surgery continues to be a subject of debate since no single method has produced outstanding results. Further clinical studies are required to see whether ergonomic advantages of the prone position can be translated into improved patient outcomes.

Keywords

Esophagectomy Esophageal neoplasms Minimally invasive surgery Prone position 

Notes

Acknowledgments

Disclosures

Drs. Omar A. Jarral, Sanjay Purkayastha, Thanos Athanasiou, Ara Darzi, George B. Hanna, and Emmanouil Zacharakis have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Omar A. Jarral
    • 1
  • Sanjay Purkayastha
    • 1
  • Thanos Athanasiou
    • 1
  • Ara Darzi
    • 1
  • George B. Hanna
    • 1
  • Emmanouil Zacharakis
    • 1
  1. 1.Department of Biosurgery and Surgical TechnologySt. Mary’s Hospital, Imperial College LondonLondonUK

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