Skip to main content
Log in

Comparison of the perioperative outcome of esophagectomy by thoracoscopy in the prone position with that of thoracotomy in the lateral decubitus position

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Traditional esophagectomy is a highly invasive procedure. Intrathoracic procedures in esophagectomy can be performed by thoracoscopy. This study compared the influence of prone positioning with that of lateral decubitus positioning on patient outcomes following esophagectomy.

Methods

This study enrolled 24 patients that underwent esophagectomy with thoracoscopy in the prone position between July 2009 and November 2010 (group P) and 24 patients that underwent thoracotomy in the lateral decubitus position between July 2007 and June 2009 (group L). The ICU and hospital stay length, pulmonary complication frequency and time until walking ability was regained were recorded.

Results

The patients’ background was not significantly different. Total blood loss and pulmonary complication frequency were significantly lower in group P than in group L [209 (SD; 146) vs. 474 (279) ml, P = 0.002, and 4 vs. 38 %, P = 0.003]. The duration of ICU stay, time until walking ability was regained and hospital stay were significantly shorter in group P than in group L [865 (103) vs. 1349 (702) min, P = 0.002, 1.0 (0.2) vs. 3.1 (2.5) POD, P < 0.001 and 23 (16) vs. 35 (15) POD, P = 0.009].

Conclusion

Thoracoscopic surgery in the prone position allows for earlier mobilization and also reduces respiratory complications.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Chang AC, Lee JS. Resection for esophageal cancer in the elderly. Thorac Surg Clin. 2009;19:333–43.

    Article  PubMed  Google Scholar 

  2. Ng JM. Update on anesthetic management for esophagectomy. Curr Opin Anesthesiol. 2011;24:37–43.

    Article  Google Scholar 

  3. Kitagawa H, Akimori T, Okabayashi T, Namikawa T, Sugimoto T, Kobayashi M, et al. Total laparoscopic gastric mobilization for esophagectomy. Langenbecks Arch Surg. 2009;394:617–21.

    Article  PubMed  Google Scholar 

  4. McMahon AJ, Russell IT, Ramsay G, Sunderland G, Baxter JN, Anderson JR, et al. Laparoscopic and minilaparotomy cholecystectomy: a randomized trial comparing postoperative pain and pulmonary function. Surgery. 1994;115:533–9.

    PubMed  CAS  Google Scholar 

  5. Frazee RC, Roberts JW, Okeson GC, Symmonds RE, Snyder SK, Hendricks JC, et al. Open versus laparoscopic cholecystectomy. A comparison of postoperative pulmonary function. Ann Surg. 1991;213:651–4.

    Article  PubMed  CAS  Google Scholar 

  6. Coelho JC, de Araujo RP, Marchesini JB, Coelho IC, de Araujo LR. Pulmonary function after cholecystectomy performed through Kocher’s incision, a mini-incision, and laparoscopy. World J Surg. 1993;17:544–6.

    Article  PubMed  CAS  Google Scholar 

  7. Choi YS, Shim JK, Na S, Hong SB, Hong YW, Oh YJ. Pressure-controlled versus volume-controlled ventilation during one-lung ventilation in the prone position for robot-assisted esophagectomy. Surg Endosc. 2009;23:2286–91.

    Article  PubMed  Google Scholar 

  8. Dapri G, Himpens J, Cadiere GB. Minimally invasive esophagectomy for cancer:laparoscopic transhiatal procedure or thoracoscopy in prone position followed by laparoscopy? Surg Endosc. 2008;22:1060–9.

    Article  PubMed  CAS  Google Scholar 

  9. Yatabe T, Kitagawa H, Yamashita K, Akimori T, Hanazaki K, Yokoyama M. Better postoperative oxygenation in thoracoscopic esophagectomy in prone positioning. J Anesth. 2010;24:803–6.

    Article  PubMed  Google Scholar 

  10. Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24:466–77.

    Article  PubMed  CAS  Google Scholar 

  11. Mohn AC, Bernardshaw SV, Ristesund SM, Hovde Hansen PE, Røkke O. Enhanced recovery after colorectal surgery. Results from a prospective observational two-centre study. Scand J Surg. 2009;98:155–9.

    PubMed  CAS  Google Scholar 

  12. Teeuwen PH, Bleichrodt RP, Strik C, Groenewoud JJ, Brinkert W, van Laarhoven CJ, et al. Enhanced recovery after surgery (ERAS) versus conventional postoperative care in colorectal surgery. J Gastrointest Surg. 2010;14:88–95.

    Article  PubMed  Google Scholar 

  13. Stoot JH, van Dam RM, Busch OR, van Hillegersberg R, De Boer M, Olde Damink SW, et al. The effect of a multimodal fast-track programme on outcomes in laparoscopic liver surgery: a multicentre pilot study. HPB (Oxford). 2009;11:140–4.

    Article  Google Scholar 

  14. Japanese Classification of Esophageal Cancer. 10th edition. Tokyo: Japan Esophageal Society, Kanehara, Co., Ltd. 2008.

  15. Nomori H, Horio H, Naruke T, Suemasu K. What is the advantage of a thoracoscopic lobectomy over a limited thoracotomy procedure for lung cancer surgery? Ann Thorac Surg. 2001;72:879–84.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  17. Maessen J, Dejong CHC, Hausel J, Nygren J, Lassen K, Andersen J, et al. A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg. 2007;94:224–31.

    Article  PubMed  CAS  Google Scholar 

  18. Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, et al. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg. 2003;238:486–95.

    PubMed  Google Scholar 

  19. Petri R, Zuccolo M, Brizzolari M, Rossit L, Rosignoli A, Durastante V, et al. Minimally invasive esophagectomy: thoracoscopic esophageal mobilization for esophageal cancer with the patient in prone position. Surg Endosc. 2012;26:1102-7.

    Google Scholar 

  20. Hoppo T, Jobe BA, Hunter JG. Minimally invasive esophagectomy: the evolution and technique of minimally invasive surgery for esophageal cancer. World J Surg. 2011;35:1454–63.

    Article  PubMed  Google Scholar 

  21. Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002;347:1662–9.

    Article  PubMed  Google Scholar 

  22. Biere SS, Maas KW, Bonavina L, Garcia JR, van Berge Henegouwen MI, Rosman C, et al. Traditional invasive vs. minimally invasive esophagectomy: a multi-center, randomized trial (TIME-trial). BMC Surg. 2011;11:2.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have no conflicts of interest to declare.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tomoaki Yatabe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yatabe, T., Kitagawa, H., Yamashita, K. et al. Comparison of the perioperative outcome of esophagectomy by thoracoscopy in the prone position with that of thoracotomy in the lateral decubitus position. Surg Today 43, 386–391 (2013). https://doi.org/10.1007/s00595-012-0375-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-012-0375-6

Keywords

Navigation