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



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.


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.


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.


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.


Esophagectomy Esophageal neoplasms Minimally invasive surgery Prone position 




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.


  1. 1.
    Kamangar F, Dores GM, Anderson WF (2006) Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 24:2137–2150PubMedCrossRefGoogle Scholar
  2. 2.
    Decker G, Coosemans W, De Leyn P, Decaluwe H, Nafteux P, Van Raemdonck D, Lerut T (2009) Minimally invasive esophagectomy for cancer. Eur J Cardiothorac Surg 35:13–20 Discussion 20–21PubMedCrossRefGoogle Scholar
  3. 3.
    Mariette C, Piessen G, Triboulet JP (2007) Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities. Lancet Oncol 8:545–553PubMedCrossRefGoogle Scholar
  4. 4.
    Millikan KW, Silverstein J, Hart V, Blair K, Bines S, Roberts J, Doolas A (1995) A 15 years review of esophagectomy for carcinoma of the esophagus and cardia. Arch Surg 130:617–624PubMedCrossRefGoogle Scholar
  5. 5.
    Ni NC, Redmond HP (2006) Cell response to surgery. Arch Surg 141:1132–1140CrossRefGoogle Scholar
  6. 6.
    Jamieson GG, Mathew G, Ludemann R, Wayman J, Myers JC, Devitt PG (2004) Postoperative mortality following oesophagectomy and problems in reporting its rate. Br J Surg 91:943–947PubMedCrossRefGoogle Scholar
  7. 7.
    Rudiger JS, Feith M, Werner M, Stein HJ (2000) Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 232:353–361CrossRefGoogle Scholar
  8. 8.
    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 Discussion 1170–1176PubMedCrossRefGoogle Scholar
  9. 9.
    Roberts JR (2006) Postoperative respiratory failure. Thorac Surg Clin 16:235–241 viPubMedCrossRefGoogle Scholar
  10. 10.
    Ell C, May A, Gossner L, Pech O, Gunter E, Mayer G, Henrich R, Vieth M, Muller H, Seitz G, Stolte M (2000) Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus. Gastroenterology 118:670–677PubMedCrossRefGoogle Scholar
  11. 11.
    Sharma VK, Wang KK, Overholt BF, Lightdale CJ, Fennerty MB, Dean PJ, Pleskow DK, Chuttani R, Reymunde A, Santiago N, Chang KJ, Kimmey MB, Fleischer DE (2007) Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett’s esophagus: 1 year follow-up of 100 patients. Gastrointest Endosc 65:185–195PubMedCrossRefGoogle Scholar
  12. 12.
    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 23:2310–2317PubMedCrossRefGoogle Scholar
  13. 13.
    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 9:794–802PubMedCrossRefGoogle Scholar
  14. 14.
    DePaula AL, Hashiba K, Ferreira EA, de Paula RA, Grecco E (1995) Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc 5:1–5PubMedGoogle Scholar
  15. 15.
    Swanstrom LL, Hansen P (1997) Laparoscopic total esophagectomy. Arch Surg 132:943–947 Discussion 947–949PubMedCrossRefGoogle Scholar
  16. 16.
    Avital S, Zundel N, Szomstein S, Rosenthal R (2005) Laparoscopic transhiatal esophagectomy for esophageal cancer. Am J Surg 190:69–74PubMedCrossRefGoogle Scholar
  17. 17.
    Watson DI, Davies N, Jamieson GG (1999) Totally endoscopic Ivor Lewis esophagectomy. Surg Endosc 13:293–297PubMedCrossRefGoogle Scholar
  18. 18.
    Nguyen NT, Follette DM, Lemoine PH, Roberts PF, Goodnight JE Jr (2001) Minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg 72:593–596PubMedCrossRefGoogle Scholar
  19. 19.
    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 Discussion 406–407PubMedCrossRefGoogle Scholar
  20. 20.
    Smithers BM, Gotley DC, Martin I, Thomas JM (2007) Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg 245:232–240PubMedCrossRefGoogle Scholar
  21. 21.
    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 135:920–925PubMedCrossRefGoogle Scholar
  22. 22.
    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 238:486–494 Discussion 494–485PubMedGoogle Scholar
  23. 23.
    Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669PubMedCrossRefGoogle Scholar
  24. 24.
    Hulscher JB, Tijssen JG, Obertop H, van Lanschot JJ (2001) Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg 72:306–313PubMedCrossRefGoogle Scholar
  25. 25.
    Nguyen NT, Roberts P, Follette DM, Rivers R, Wolfe BM (2003) Thoracoscopic and laparoscopic esophagectomy for benign and malignant disease: lessons learned from 46 consecutive procedures. J Am Coll Surg 197:902–913PubMedCrossRefGoogle Scholar
  26. 26.
    Boone J, Livestro DP, Elias SG, Borel RIH, van Hillegersberg R (2009) International survey on esophageal cancer: part I surgical techniques. Dis Esophagus 22:195–202PubMedCrossRefGoogle Scholar
  27. 27.
    Collard JM, Lengele B, Otte JB, Kestens PJ (1993) En bloc and standard esophagectomies by thoracoscopy. Ann Thorac Surg 56:675–679PubMedCrossRefGoogle Scholar
  28. 28.
    Robertson GS, Lloyd DM, Wicks AC, Veitch PS (1996) No obvious advantages for thoracoscopic two-stage oesophagectomy. Br J Surg 83:675–678PubMedCrossRefGoogle Scholar
  29. 29.
    McAnena OJ, Rogers J, Williams NS (1994) Right thoracoscopically assisted oesophagectomy for cancer. Br J Surg 81:236–238PubMedCrossRefGoogle Scholar
  30. 30.
    Dexter SP, Martin IG, McMahon MJ (1996) Radical thoracoscopic esophagectomy for cancer. Surg Endosc 10:147–151PubMedGoogle Scholar
  31. 31.
    Ashrafi AS, Keeley SB, Shende M, Luketich J (2007) Minimally invasive esophagectomy. Eur Surg 39:141–150CrossRefGoogle Scholar
  32. 32.
    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 53:413–419PubMedCrossRefGoogle Scholar
  33. 33.
    Watson DI, Jamieson GG, Devitt PG (2000) Endoscopic cervico-thoraco-abdominal esophagectomy. J Am Coll Surg 190:372–378PubMedCrossRefGoogle Scholar
  34. 34.
    Berrisford RG, Wajed SA, Sanders D, Rucklidge MW (2008) Short-term outcomes following total minimally invasive oesophagectomy. Br J Surg 95:602–610PubMedCrossRefGoogle Scholar
  35. 35.
    Palanivelu C, Prakash A, Parthasarathi R, Senthilkumar R, Senthilnathan PR, Rajapandian S (2007) Laparoscopic esophagogastrectomy without thoracic or cervical access for adenocarcinoma of the gastroesophageal junction: an Indian experience from a tertiary center. Surg Endosc 21:16–20PubMedCrossRefGoogle Scholar
  36. 36.
    Hamouda AH, Forshaw MJ, Tsigritis K, Jones GE, Noorani AS, Rohatgi A, Botha AJ (2010) Perioperative outcomes after transition from conventional to minimally invasive Ivor-Lewis esophagectomy in a specialized center. Surg Endosc 24:865–869PubMedCrossRefGoogle Scholar
  37. 37.
    Nagpal K, Ahmed K, Vats A, Yakoub D, James D, Ashrafian H, Darzi A, Moorthy K, Athanasiou T (2010) Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc 24:1621–1629PubMedCrossRefGoogle Scholar
  38. 38.
    Gemmill EH, McCulloch P (2007) Systematic review of minimally invasive resection for gastro-oesophageal cancer. Br J Surg 94:1461–1467PubMedCrossRefGoogle Scholar
  39. 39.
    Law S (2006) Minimally invasive techniques for oesophageal cancer surgery. Best Pract Res Clin Gastroenterol 20:925–940PubMedCrossRefGoogle Scholar
  40. 40.
    Cuschieri A (1994) Thoracoscopic subtotal oesophagectomy. Endosc Surg Allied Technol 2:21–25PubMedGoogle Scholar
  41. 41.
    Palanivelu C, Rangarajan M, Senthilkumar R, Velusamy M (2008) Combined thoracoscopic and endoscopic management of mid-esophageal benign lesions: use of the prone patient position: thoracoscopic surgery for mid-esophageal benign tumors and diverticula. Surg Endosc 22:250–254PubMedCrossRefGoogle Scholar
  42. 42.
    Spinoglio G, Summa M, Quarati R, Testa S, Priora F, Lenti M, Ravazzoni F, Piscioneri D (2009) Thoracoscopic and laparoscopic esophagectomy in a case of spontaneous rupture of the esophagus (Boerhaave’s syndrome). Eur J Trauma Emerg Surg 35:414–416CrossRefGoogle Scholar
  43. 43.
    Denk PM, Gatta P, Swanstrom LL (2008) Multimedia article. Prone thoracoscopic thoracic duct ligation for postsurgical chylothorax. Surg Endosc 22:2742PubMedCrossRefGoogle Scholar
  44. 44.
    Dapri G, Himpens J, Cadiere GB (2008) Minimally invasive esophagectomy for cancer: laparoscopic transhiatal procedure or thoracoscopy in prone position followed by laparoscopy? Surg Endosc 22:1060–1069PubMedCrossRefGoogle Scholar
  45. 45.
    Cadiere GB, Torres R, Dapri G, Capelluto E, Hainaux B, Himpens J (2006) Thoracoscopic and laparoscopic oesophagectomy improves the quality of extended lymphadenectomy. Surg Endosc 20:1308–1309PubMedCrossRefGoogle Scholar
  46. 46.
    Cadiere GB, Dapri G, Himpens J, Fodderie L, Rajan A (2010) Ivor Lewis esophagectomy with manual esogastric anastomosis by thoracoscopy in prone position and laparoscopy. Surg Endosc 24:1482–1485PubMedCrossRefGoogle Scholar
  47. 47.
    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—experience of 130 patients. J Am Coll Surg 203:7–16PubMedCrossRefGoogle Scholar
  48. 48.
    Fabian T, McKelvey AA, Kent MS, Federico JA (2007) Prone thoracoscopic esophageal mobilization for minimally invasive esophagectomy. Surg Endosc 21:1667–1670PubMedCrossRefGoogle Scholar
  49. 49.
    Noshiro H, Iwasaki H, Kobayashi K, Uchiyama A, Miyasaka Y, Masatsugu T, Koike K, Miyazaki K (2010) Lymphadenectomy along the left recurrent laryngeal nerve by a minimally invasive esophagectomy in the prone position for thoracic esophageal cancer. Surg Endosc 24:2965–2973PubMedCrossRefGoogle Scholar
  50. 50.
    Altorki NK, Girardi L, Skinner DB (1997) En bloc esophagectomy improves survival for stage III esophageal cancer. J Thorac Cardiovasc Surg 114:948–955 Discussion 955–946PubMedCrossRefGoogle Scholar
  51. 51.
    Nishihira T, Hirayama K, Mori S (1998) A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus. Am J Surg 175:47–51PubMedCrossRefGoogle Scholar
  52. 52.
    Siewert JR, Stein HJ (1999) Lymph-node dissection in squamous cell esophageal cancer—who benefits? Langenbecks Arch Surg 384:141–148PubMedCrossRefGoogle Scholar
  53. 53.
    Hofstetter W, Swisher SG, Correa AM, Hess K, Putnam JB Jr, Ajani JA, Dolormente M, Francisco R, Komaki RR, Lara A, Martin F, Rice DC, Sarabia AJ, Smythe WR, Vaporciyan AA, Walsh GL, Roth JA (2002) Treatment outcomes of resected esophageal cancer. Ann Surg 236:376–384 Discussion 384–375PubMedCrossRefGoogle Scholar
  54. 54.
    Orringer MB, Marshall B, Chang AC, Lee J, Pickens A, Lau CL (2007) Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg 246:363–372 Discussion 372–364PubMedCrossRefGoogle Scholar
  55. 55.
    Low DE, Kunz S, Schembre D, Otero H, Malpass T, Hsi A, Song G, Hinke R, Kozarek RA (2007) Esophagectomy–it’s not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer. J Gastrointest Surg 11:1395–1402 Discussion 1402PubMedCrossRefGoogle Scholar
  56. 56.
    Bryan AC (1974) Conference on the scientific basis of respiratory therapy. Pulmonary physiotherapy in the pediatric age group. Comments of a devil’s advocate. Am Rev Respir Dis 110:143–144PubMedGoogle Scholar
  57. 57.
    Nyren S, Mure M, Jacobsson H, Larsson SA, Lindahl SG (1999) Pulmonary perfusion is more uniform in the prone than in the supine position: scintigraphy in healthy humans. J Appl Physiol 86:1135–1141PubMedGoogle Scholar
  58. 58.
    Langer M, Mascheroni D, Marcolin R, Gattinoni L (1988) The prone position in ARDS patients. A clinical study. Chest 94:103–107PubMedCrossRefGoogle Scholar
  59. 59.
    Pappert D, Rossaint R, Slama K, Gruning T, Falke KJ (1994) Influence of positioning on ventilation-perfusion relationships in severe adult respiratory distress syndrome. Chest 106:1511–1516PubMedCrossRefGoogle Scholar
  60. 60.
    Chatte G, Sab JM, Dubois JM, Sirodot M, Gaussorgues P, Robert D (1997) Prone position in mechanically ventilated patients with severe acute respiratory failure. Am J Respir Crit Care Med 155:473–478PubMedGoogle Scholar
  61. 61.
    Pelosi P, Tubiolo D, Mascheroni D, Vicardi P, Crotti S, Valenza F, Gattinoni L (1998) Effects of the prone position on respiratory mechanics and gas exchange during acute lung injury. Am J Respir Crit Care Med 157:387–393PubMedGoogle Scholar
  62. 62.
    Guerin C, Badet M, Rosselli S, Heyer L, Sab JM, Langevin B, Philit F, Fournier G, Robert D (1999) Effects of prone position on alveolar recruitment and oxygenation in acute lung injury. Intensive Care Med 25:1222–1230PubMedCrossRefGoogle Scholar
  63. 63.
    Albert RK, Hubmayr RD (2000) The prone position eliminates compression of the lungs by the heart. Am J Respir Crit Care Med 161:1660–1665PubMedGoogle Scholar
  64. 64.
    Demory D, Michelet P, Arnal JM, Donati S, Forel JM, Gainnier M, Bregeon F, Papazian L (2007) High-frequency oscillatory ventilation following prone positioning prevents a further impairment in oxygenation. Crit Care Med 35:106–111PubMedCrossRefGoogle Scholar
  65. 65.
    Froese AB, Bryan AC (1974) Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 41:242–255PubMedCrossRefGoogle Scholar
  66. 66.
    Yatabe T, Kitagawa H, Yamashita K, Akimori T, Hanazaki K, Yokoyama M (2010) Better postoperative oxygenation in thoracoscopic esophagectomy in prone positioning. J Anesth 24:803–806PubMedCrossRefGoogle Scholar
  67. 67.
    Atsuta J, Okutani R, Kobayashi M (2010) Which is less invasive procedure in thoracoscopic esophagectomy? Lateral vs. prone position. American Society of Anesthesiologists 2010 Meeting, San Diego October 16–20 2010, abstract A1083Google Scholar
  68. 68.
    Laface L, Abate E, Agosteo EA, Nencioni M, Asti E, Saino G, Bona D, Bonavina L (2010) 51st annual meeting of the society for surgery of the alimentary tract. New Orleans, LA May 1–5 2010, abstract T1646Google Scholar
  69. 69.
    Watanabe I, Fujihara H, Sato K, Honda T, Ohashi S, Endoh H, Yamakura T, Taga K, Shimoji K (2002) Beneficial effect of a prone position for patients with hypoxemia after transthoracic esophagectomy. Crit Care Med 30:1799–1802PubMedCrossRefGoogle Scholar
  70. 70.
    Kim DJ, Hyung WJ, Lee CY, Lee JG, Haam SJ, Park IK, Chung KY (2010) Thoracoscopic esophagectomy for esophageal cancer: feasibility and safety of robotic assistance in the prone position. J Thorac Cardiovasc Surg 139(53–59):e51Google Scholar
  71. 71.
    Funakoshi T, Ishibe Y, Okazaki N, Miura K, Liu R, Nagai S, Minami Y (2004) Effect of re-expansion after short-period lung collapse on pulmonary capillary permeability and pro-inflammatory cytokine gene expression in isolated rabbit lungs. Br J Anaesth 92:558–563PubMedCrossRefGoogle Scholar
  72. 72.
    Kernstine KH, DeArmond DT, Karimi M, Van Natta TL, Campos JH, Yoder MR, Everett JE (2004) The robotic, 2-stage, 3-field esophagolymphadenectomy. J Thorac Cardiovasc Surg 127:1847–1849PubMedCrossRefGoogle Scholar
  73. 73.
    Ruurda JP, van Vroonhoven TJ, Broeders IA (2002) Robot-assisted surgical systems: a new era in laparoscopic surgery. Ann R Coll Surg Engl 84:223–226PubMedCrossRefGoogle Scholar
  74. 74.
    Hanly EJ, Talamini MA (2004) Robotic abdominal surgery. Am J Surg 188:19S–26SPubMedCrossRefGoogle Scholar
  75. 75.
    Dapri G, Himpens J, Cadiere GB (2006) Robot-assisted thoracoscopic esophagectomy with the patient in the prone position. J Laparoendosc Adv Surg Tech A 16:278–285PubMedCrossRefGoogle Scholar
  76. 76.
    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 17:515–519PubMedCrossRefGoogle Scholar
  77. 77.
    Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K (2010) Quantitative comparison of the difficulty of performing laparoscopic colectomy at different tumor locations. World J Surg 34:133–139PubMedCrossRefGoogle Scholar
  78. 78.
    Smithers BM, Gotley DC, McEwan D, Martin I, Bessell J, Doyle L (2001) Thoracoscopic mobilization of the esophagus. A 6 year experience. Surg Endosc 15:176–182PubMedCrossRefGoogle Scholar
  79. 79.
    Mariette C, Piessen G, Balon JM, Van Seuningen I, Triboulet JP (2004) Surgery alone in the curative treatment of localised oesophageal carcinoma. Eur J Surg Oncol 30:869–876PubMedCrossRefGoogle Scholar
  80. 80.
    Dunst CM, Swanstrom LL (2010) Minimally invasive esophagectomy. J Gastrointest Surg 14(Suppl 1):S108–S114PubMedCrossRefGoogle Scholar
  81. 81.
    Kuwabara S, Katayanagi N (2010) Comparison of three different operative methods of video-assisted thoracoscopic esophagectomy. Esophagus 7:23–29CrossRefGoogle Scholar
  82. 82.
    Song SY, Na KJ, Oh SG, Ahn BH (2009) Learning curves of minimally invasive esophageal cancer surgery. Eur J Cardiothorac Surg 35:689–693PubMedCrossRefGoogle Scholar
  83. 83.
    Fabian T, Martin J, Katigbak M, McKelvey AA, Federico JA (2008) Thoracoscopic esophageal mobilization during minimally invasive esophagectomy: a head-to-head comparison of prone versus decubitus positions. Surg Endosc 22:2485–2491PubMedCrossRefGoogle Scholar
  84. 84.
    Leibman S, Smithers BM, Gotley DC, Martin I, Thomas J (2006) Minimally invasive esophagectomy: short- and long-term outcomes. Surg Endosc 20:428–433PubMedCrossRefGoogle Scholar
  85. 85.
    Martin DJ, Bessell JR, Chew A, Watson DI (2005) Thoracoscopic and laparoscopic esophagectomy: initial experience and outcomes. Surg Endosc 19:1597–1601PubMedCrossRefGoogle Scholar
  86. 86.
    Zingg U, McQuinn A, DiValentino D, Esterman AJ, Bessell JR, Thompson SK, Jamieson GG, Watson DI (2009) Minimally invasive versus open esophagectomy for patients with esophageal cancer. Ann Thorac Surg 87:911–919PubMedCrossRefGoogle Scholar

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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