Thoracolaparoscopic Esophagectomy in the Prone Position for Carcinoma of the Esophagus

Abstract

In open surgery for intrathoracic esophageal tumors/carcinoma, transhiatal esophagectomy was used for tumors in the lower third of the esophagus and a transthoracoscopic McKeown three-hole/three-field approach with cervical anastomosis was used for tumors in the middle and upper thirds of the esophagus. Initially, we followed the same principles when using a laparoscopic approach. Our standard approach for thoracoscopic esophagectomies is with the patient in the prone position.

The use of thoracoscopic esophagectomy in the prone position for esophageal cancer was first reported by Cushieri et al. in 1992. Subsequently, no other groups reported using this approach. Many esophageal surgeons have been interested in performing minimally invasive esophagectomy for cancer. All of the cases reported in the literature reported using video-assisted thoracoscopic (VATS) esophagectomy with the patient in the lateral decubitus position. After 10 years, this author’s report of 130 cases using the approach with the patient in the prone position created great enthusiasm among many surgeons across the world, including those in Japan, Korea, and Europe. The author’s video using this approach received best technique awards in various congresses such as the American College of Surgeons (ACS) in 2005, the 16th European Congress at Stockholm, and the 10th World Congress of the International Society for Diseases of the Esophagus. The author performed a live thoracolaparoscopic esophagectomy on a patient in the prone position for esophageal cancer during the Hong Kong Asia Pacific Congress (ELSA) in 2005, which created great enthusiasm among the Asian group.