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Three-dimensional visualization system is one of the factors that improve short-term outcomes after minimally invasive esophagectomy

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Abstract

Purpose

Minimally invasive esophagectomy (MIE) has been increasingly used, but many reports have stated that recurrent laryngeal nerve (RLN) palsy after MIE is a major complication associated with postoperative pneumonia. Prevention of RLN palsy clearly has been a challenging task. The study aim was to determine if a three-dimensional (3-D) stereoscopic vision system can reduce the RLN palsy rate after MIE.

Methods

This was a retrospective study of MIE (McKeown esophagectomy) using a 3-D or 2-D stereoscopic vision system to treat 358 patients in the prone position between April 2010 and March 2019. The patients who underwent 3-D MIE (3-D group) or 2-D MIE (2-D group) were matched by using propensity score matching. After matching, the perioperative outcomes were compared between the groups.

Results

After propensity score matching, 154 patients were analyzed (77 patients, 3-D group; 77 patients, 2-D group). There were no significant differences in the patients’ baseline characteristics in the matched cohort. There were no significant differences in the rates of pneumonia (Clavien–Dindo (C–D) grade ≥ II, 3-D vs. 2-D, 11 (14%) vs. 12 (16%)), anastomotic leakage (C–D grade ≥ II, 10 (13%) vs. 18 (23%)) and mortality. The rates of left RLN palsy (C–D grade ≥ IIIa, 1 (1.3%) vs. 7 (9.1%), P = 0.029), right RLN palsy (C–D grade ≥ I, 2 (3%) vs. 8 (10%), P = 0.049), comprehensive complication index (CCI®) (8.5 vs. 14.3, P = 0.011), and postoperative hospital stay period (median: 25 vs. 30 days, P = 0.034) were significantly lower in the 3-D group than in the 2-D group, respectively.

Conclusions

In MIE, the 3-D viewing system was one of the factors that reduced postoperative morbidities such as the rates of each RLN palsy and CCI®, leading to shorter postoperative hospital stay.

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Data availability

The datasets generated during and analyzed during the current study are not publicly available due to medical data included participants’ personal data.

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Author information

Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Takuya Kudo, Taro Oshikiri, Gosuke Takiguchi, Naoki Urakawa, Hiroshi Hasegawa, Masashi Yamamoto, Shingo Kanaji, Yoshiko Matsuda, Kimihiro Yamashita, Tetsu Nakamura & Yoshihiro Kakeji

  2. Division of Minimally Invasive Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Takeru Matsuda

  3. Division of Community Medicine and Medical Network, Department of Social Community Medicine and Health Science, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Satoshi Suzuki

Authors
  1. Takuya Kudo
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  2. Taro Oshikiri
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  3. Gosuke Takiguchi
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  8. Yoshiko Matsuda
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  9. Kimihiro Yamashita
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  13. Yoshihiro Kakeji
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Takuya Kudo and Oshikiri Taro. The first draft of the manuscript was written by Takuya Kudo and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Taro Oshikiri.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

Approval was obtained from the ethics committee of Kobe University. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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Not applicable.

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Kudo, T., Oshikiri, T., Takiguchi, G. et al. Three-dimensional visualization system is one of the factors that improve short-term outcomes after minimally invasive esophagectomy. Langenbecks Arch Surg 406, 631–639 (2021). https://doi.org/10.1007/s00423-020-02028-1

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  • DOI: https://doi.org/10.1007/s00423-020-02028-1

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