scholarly journals Prone Position Is Useful in Thoracoscopic Enucleation of Esophageal Leiomyoma

2015 ◽  
Vol 9 (2) ◽  
pp. 165-170 ◽  
Author(s):  
Kenji Maki ◽  
Shinsuke Takeno ◽  
Satoshi Nimura ◽  
Ippei Yamana ◽  
Hideki Shimaoka ◽  
...  
Keyword(s):  
Prone Position ◽  
Submucosal Tumor ◽  
Endoscopic Examination ◽  
Esophageal Leiomyoma ◽  
Immunohistochemical Examination ◽  
Left Lateral Decubitus Position ◽  
Remarkable Event ◽  
Thoracoscopic Enucleation ◽  
Lateral Decubitus ◽  
Upper Gastrointestinal

A 36-year-old man was admitted to our institute due to the diagnosis of esophageal submucosal tumor detected by a periodical upper gastrointestinal endoscopic examination without any complaint. Thoracoscopic enucleation of the lesion with the preoperative clinical diagnosis of esophageal leiomyoma was performed under general anesthesia in the prone position. After immunohistochemical examination, the pathological diagnosis was leiomyoma. There was no remarkable event during the postoperative hospital stay, and the patient was discharged on the 12th day after surgery. This case report suggests that the prone position might be superior to the left lateral decubitus position in thoracoscopic enucleation of esophageal leiomyoma.

RA04.01: PRONE POSITION IN THORACOSCOPIC ESOPHAGECTOMY IMPROVES POSTOPERATIVE OXYGENATION AND REDUCES PULMONARY COMPLICATIONS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 24-25
Author(s):  
Yoshihiro Kakeji ◽  
Dai Otsubo ◽  
Gosuke Takiguchi ◽  
Taro Oshikiri ◽  
Tetsu Nakamura
Keyword(s):  
Pulmonary Function ◽  
Prone Position ◽  
Surgical Procedure ◽  
Body Position ◽  
Lateral Decubitus Position ◽  
Thoracoscopic Esophagectomy ◽  
Respiratory Complications ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus ◽  
Position Group

Abstract Background While thoracoscopic esophagectomy is a widely performed surgical procedure, only few studies regarding the influence of body position on changes in circulation and breathing, after the surgery, have been reported. This study aimed at evaluating the effect of body position, during surgery, on the postoperative breathing functions of the chest. Methods A total of 266 patients who underwent right-sided transthoracic esophagectomy for esophageal cancer from 2004 to 2012 were included in this study. Fifty-four of them underwent open thoracotomies in the left lateral decubitus position (Group O), 108 underwent thoracoscopic esophagectomy in the left lateral decubitus position (Group L) and 104 patients were treated by thoracoscopic esophagectomy in the prone position (Group P). Two patients in Group P, who presented with intra-operative bleeding and underwent thoracotomy, were subsequently excluded from the pulmonary function analysis. Results Two patients in Group P had to be changed from the prone position to the lateral decubitus position and underwent thoracotomy in order to control intra-operative bleeding. Despite the significantly longer chest operation period in Group P, total blood loss was significantly lower in this group when compared to Groups O and L. Furthermore, patients in Group P presented with significantly lower water balance during the perioperative period and markedly higher SpO2/FiO2 ratio after the surgery. The incidence of respiratory complications was significantly higher in Group O when compared to the other two groups; however, no significant differences were observed between the Groups L and P. Conclusion From a surgical point of view, artificial pneumothorax and gravity improves the operative field view in the prone position without any compression of the right lung, thereby resulting in no mechanical damage to the lungs. Prone position esophagectomy is a useful surgical technique, which appears to preserve the postoperative pulmonary function. The patients are able to endure the surgical procedure and present with less respiratory complications. Disclosure All authors have declared no conflicts of interest.

Thoracoscopic Enucleation of Esophageal Submucosal Tumor by Prone Position Under Artificial Pneumothorax by CO2 Insufflation

2014 ◽  
Vol 24 (2) ◽  
pp. e55-e58 ◽  
Author(s):  
Toshiaki Shichinohe ◽  
Kentaro Kato ◽  
Yuma Ebihara ◽  
Yo Kurashima ◽  
Takahiro Tsuchikawa ◽  
...  
Keyword(s):  
Prone Position ◽  
Submucosal Tumor ◽  
Co2 Insufflation ◽  
Artificial Pneumothorax ◽  
Thoracoscopic Enucleation

106 THE HYBRID POSITION IS SUPERIOR TO THE PRONE POSITION FOR THORACOSCOPIC ESOPHAGECTOMY WITH UPPER MEDIASTINAL LYMPHADENECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
H Kikuchi ◽  
Y Hiramatsu ◽  
W Soneda ◽  
S Kawata ◽  
A Hirotsu ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Prone Position ◽  
Operation Time ◽  
Laryngeal Nerve ◽  
Thoracoscopic Esophagectomy ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Paralysis ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus

Abstract   Thoracoscopic esophagectomy (TE) is becoming a common surgical method for esophageal cancer. TE is performed with the patient the left lateral decubitus position, prone position, or hybrid position combining the left lateral decubitus and prone positions. However, only few studies have compared the clinical utility of these TE positions. Methods In our institute, we introduced TE in the prone position (prone TE) in 2014, and have performed TE in the hybrid position (hybrid TE) since March 2017. The present study compared the short-term outcomes of prone TE versus hybrid TE. One-hundred-and-three patients with esophageal or esophagogastric junction cancer who underwent TE between March 2014 and December 2019 were included. Patients were divided into those who underwent prone TE (prone TE group; n = 43) and those who underwent hybrid TE (hybrid TE group; n = 60). Clinicopathological data were retrospectively reviewed and compared between groups. Results There were no differences between groups in age, tumor histology, and tumor location. Compared with the hybrid TE group, the prone TE group had a smaller tumor depth (P < 0.001), lower grade of lymph node metastasis (P = 0.003), and less severe tumor stage (P = 0.001). The operation time for the thoracoscopic procedure was shorter in the hybrid TE group (318.9 vs 249.2 min, P = 0.002). The rate of recurrent laryngeal nerve paralysis (Clavien-Dindo grade I–III) was significantly lower in the hybrid TE group (41.9% vs 11.7%, P < 0.001), whereas there were no differences between groups in the rates of anastomotic leakage, atelectasis, or pneumonia. Conclusion The most significant differences between prone TE and hybrid TE involved the upper mediastinal procedures. In hybrid TE, the motion of the assistant’s forceps causes less interference with the operative field, and the angle at which the operator's forceps approach the upper mediastinal lymph nodes enables the maintenance of appropriate traction. These advantages of hybrid TE appeared to result in a shorter operation time and less recurrent laryngeal nerve paralysis compared with prone TE.

scholarly journals Optimal Positioning for ERCP: Efficacy and Safety of ERCP in Prone versus Left Lateral Decubitus Position

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Mashal Batheja ◽  
M. Edwyn Harrison ◽  
Ananya Das ◽  
Rodney Engel ◽  
Michael Crowell
Keyword(s):  
Bile Duct ◽  
Prone Position ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Efficacy And Safety ◽  
Inclusion Criteria ◽  
Left Lateral Decubitus Position ◽  
Potential Alternative ◽  
Lateral Decubitus

Background. ERCP is customarily performed with the patient in prone position. For patients intolerant of prone positioning, ERCP in left lateral decubitus (LLD) position offers a potential alternative. Aims. To compare efficacy and safety of ERCP in the LLD position versus prone position. Methods. Consecutive ERCP reports from August 2009 to October 2010 at Mayo Clinic Arizona were reviewed. Inclusion criteria. Age > 18 years, native papilla, and biliary indication. Primary outcome measure. Bile duct cannulation rate. Secondary outcomes. Times to ampullary localization and bile duct cannulation and complication rate. Results. ERCPs reviewed from 59 patients in two positions: 39 prone and 20 LLD. Cannulation Rate. 100% prone versus 90% in LLD (P=0.11). Median (IRQ) times. (1) Ampullary localization: 90 sec (70–110) prone versus 100 sec (80–118) (P=0.16); (2) bile duct cannulation: 140 sec (45–350) prone versus 165 sec (55–418) LLD (P=0.54). Complications. No periprocedure; postprocedure 4 (10%) prone versus 3 (15%) LLD (P=0.65). Conclusion. ERCP performed in LLD position allowed deep bile duct cannulation in 90% of patients without significantly increased procedural times or rate of complications as compared to prone position.

VS01.07: THORACOSCOPIC ESOPHAGECTOMY WITH A HYBRID OF THE PRONE AND LEFT LATERAL DECUBITUS POSITIONS FOR ESOPHAGEAL CARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 45-45
Author(s):  
Hirofumi Kawakubo ◽  
Shuhei Mayanagi ◽  
Yuko Kitagawa
Keyword(s):  
Prone Position ◽  
Conflicts Of Interest ◽  
Invasive Procedure ◽  
Massive Bleeding ◽  
Lateral Decubitus Position ◽  
Thoracoscopic Esophagectomy ◽  
Operating Table ◽  
Left Lateral Decubitus Position ◽  
Artificial Pneumothorax ◽  
Lateral Decubitus

Abstract Description Because esophagectomy with radical lymphadenectomy is highly invasive, thoracoscopic esophagectomy (TE) is attracting attention as a less invasive procedure. We first performed TE with the left decubitus position in 1996. In 2009 we developed a hybrid of the prone and left lateral decubitus positions for TE, and a total of 420 patients underwent TE with a hybrid position. We introduced TE with a hybrid position for the following three reasons: (1) Mobilization and lymphadenectomy around the middle and lower esophagus are easier in the prone position. Thanks to artificial pneumothorax and the gravity, the middle and lower mediastinum are opened, and which give us good surgical field. (2) Lymphadenectomy along the left recurrent laryngeal nerve (RLN) is more reliable and precise when performed in the left lateral decubitus position. We can dissect lymph node around the RLN higher position in the upper mediastinum. (3) Unexpected events requiring conversion to thoracotomy (e.g. massive bleeding, injury of other organs, dense intrathoracic adhesion, resection of adjacent organs) are easier to deal with in the left lateral decubitus position. The patient is fixed on the operating table with the semi-prone position and we can easily change patient positions from the left lateral decubitus position to the prone position and vice versa using rotation system of the operation table. The upper mediastinal procedure including lymphadenectomy along the right and left RLN is performed with the patient in the left lateral decubitus position, while the middle and lower mediastinal procedures are performed with the patient in the prone position with artificial pneumothorax (7mmHg). The abdominal procedures have beenwere performed by hand-assisted laparoscopic surgery (HALS) and gastric tube reconstruction in thethrough a posterior mediastinal route was performed as s a standard surgical procedure in our institution. The magnifying effect of thoracoscope enables us to perform more precise surgery and preserve nerve and vessels, and a hybrid position is thought to be feasible and effective methods. Disclosure All authors have declared no conflicts of interest.

Thoracoscopic enucleation of esophageal leiomyoma in prone position and single lumen endotracheal intubation

2013 ◽  
Vol 27 (9) ◽  
pp. 3364-3369 ◽  
Author(s):  
C. M. P. Claus ◽  
A. M. Cury Filho ◽  
P. C. Boscardim ◽  
P. C. Andriguetto ◽  
M. P. Loureiro ◽  
...  
Keyword(s):  
Endotracheal Intubation ◽  
Prone Position ◽  
Esophageal Leiomyoma ◽  
Single Lumen ◽  
Thoracoscopic Enucleation

A hybrid of the prone and left lateral decubitus positions for thoracoscopic esophagectomy with extended LN dissection for esophageal squamous cell carcinoma.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 402-402
Author(s):  
Hirofumi Kawakubo ◽  
Shuhei Mayanagi ◽  
Satoru Matsuda ◽  
Yuko Kitagawa
Keyword(s):  
Prone Position ◽  
Clinical Stage ◽  
Operation Time ◽  
Lateral Decubitus Position ◽  
Thoracoscopic Esophagectomy ◽  
Thoracic Esophagus ◽  
Recurrent Nerve ◽  
Number Of Patients ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus

402 Background: We first performed thoracoscopic esophagectomy (TE) as a minimally invasive procedure with the left decubitus position in 1996. In 2009 we developed a hybrid of the prone and left lateral decubitus positions for TE with extended LN dissection (Extensive-TE). The patient is fixed with the semi-prone position and we can easily change patient positions from the left lateral decubitus position to the prone position using rotation system of the operation table. The upper mediastinal procedure including lymphadenectomy along the right and left recurrent laryngeal nerve (RLN) is performed with the patient in the left lateral decubitus position, while the middle and lower mediastinal procedures are performed with the patient in the prone position with artificial pneumothorax. Methods: ESCC patients who underwent Extensive-TE between January 2009 and December 2016, were retrospectively reviewed. The patients’ background, surgical outcomes, postoperative complications and recurrence-free survival (RFS) were studied. Results: Primary tumor was located in Cervical esophagus for 2 (1%), the upper-thoracic esophagus for 28 (15%), the mid-thoracic esophagus for 104 (54%) and the lower-thoracic esophagus for 57 (30%). Thenumber of patients classified with pre-treatment clinical stage of 1/2/3/4 was 94(49%)/42(22%)/46(24%)/9(5%), respectively. Eight patients were evaluated as having cM1 disease due to supraclavicular LN metastasis. The number of patients classified with postoperative pathological stage of 0/1/2/3/4 was 5(3%)/70(37%)/48(26%)/49(27%)/19(7%), respectively. The average total operation time was 542.1 and blood loss was 274.2. The incidence of postoperative pneumonia, anastomotic leakage, chylothorax, and recurrent nerve palsy was 17%, 14%, 2%, and 7% respectively. One patient died postoperatively within 90 days after surgery. Three years RFSwith clinical stage of 1/2/3+4 was 91.5%/54.8%/51.9%, respectively. Conclusions: The magnifying effect of thoracoscopy enables us to perform more precise surgery and preserve nerve and vessels. Extensive-TEwith a hybrid position is thought to be feasible and effective methods.

scholarly journals Clinical Applicability of Various Treatment Approaches for Upper Gastrointestinal Submucosal Tumors

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Jing Zhang ◽  
Kaili Huang ◽  
Shigang Ding ◽  
Ye Wang ◽  
Te Nai ◽  
...  
Keyword(s):  
Endoscopic Therapy ◽  
Submucosal Tumor ◽  
Screening Method ◽  
Endoscopic Examination ◽  
Main Approach ◽  
Submucosal Tunneling Endoscopic Resection ◽  
Submucosal Tumors ◽  
Endoscopic Methods ◽  
Upper Gastrointestinal ◽  
Selection Of

Submucosal tumor (SMT) is a disease that is commonly discovered during endoscopic examination. With advances in endoscopic ultrasonography (EUS) technology, this technique has become the primary screening method for the diagnosis of upper gastrointestinal SMTs. The present study summarized the clinical data of patients who were examined and diagnosed with upper gastrointestinal SMTs by EUS, underwent endoscopic therapy or surgical treatment, and received final pathological results in our hospital between January 2011 and September 2014. Our results show that endoscopic therapy has become the main approach for the treatment of upper gastrointestinal SMTs with the development and maturation of endoscopic technology in recent years. Our conclusion suggests that the selection of endoscopic methods, such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and peroral submucosal tunneling endoscopic resection (STER), under the guidance of EUS is safe and effective for the treatment of upper gastrointestinal SMTs.

The usefulness of EUS elastography in the diagnosis of upper gastrointestinal submucosal tumor

Endoscopy ◽  
2011 ◽  
Vol 43 (S 03) ◽  
Author(s):  
Kai Xu ◽  
Ping Xu ◽  
Da-bin Ren ◽  
Jing Wang ◽  
Hai-bin Yu
Keyword(s):  
Submucosal Tumor ◽  
Eus Elastography ◽  
Upper Gastrointestinal
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