Esophageal surgery has developed for almost 100 years. Esophagectomy can be performed via left, right thoracotomy, even via hiatus without thoracotomy due to its unique anatomic characteristics. Left thoracotomy was the initial approach in the world, and has still been performed by Chinese colleagues, but Ivor Lewis (right side thoracotomy) procedure is popular in western countries. Currently, esophagectomy by right thoracotomy has been accepted worldwide since its radical dissection for tumor. Therefore, video-assisted thoracoscopic esophagectomy based on right thoracotomy will be the mainstream surgery for esophageal cancer in the future since its minimal invasion and tumor dissection.
Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Thoracoscopy ; methods

Humans ; Sympathectomy ; adverse effects ; methods ; Thoracoscopy ; adverse effects ; methods

OBJECTIVETo evaluate the outcomes of thoraco laparoscopic esophagectomy venus open esophagectomy for esophageal cancer.

METHODSLiterature search was performed using PubMed, Embase, Cochrane Library, and Google Scholar databases, CBM, and CNKI from inception to July 2011 for comparative studies assessing thoraco laparoscopic esophagectomy and open esophagectomy. Data were extracted and evaluated by two reviewers independently according to the Cochrane Handbook for Systematic Reviews. Meta-analyses were conducted using RevMan 5.1.

RESULTSA total of 10 studies involving 1017 patients were included for the analysis. Four hundred and fifty-five patients underwent thoraco laparoscopic esophagectomy and 562 patients underwent open esophagectomy. There were no significant differences between the two groups in anastomotic leak, 30-day mortality, and number of lymph node retrieved(P>0.05). However, thoraco laparoscopic esophagectomy had lower blood loss, less operative time, and reduced respiratory complications(P<0.05). There were no significant differences between the two groups in overall complications, cardiac complications, anastomotic stricture, recurrent laryngeal nerve injury, length of stay, ICU stay, and 3-year survival(all P>0.05).

CONCLUSIONThoraco laparoscopic esophagectomy for esophageal cancer is feasible and safe as open esophagectomy.

Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Laparoscopy ; Thoracoscopy ; Treatment Outcome

OBJECTIVETo study the feasibility and early results of radical resection of esophageal carcinoma using single-port thoracoscopy combined with laparoscopy.

METHODSFrom March 2010 to December 2010, 6 patients with esophageal carcinoma underwent radical resection by single-port thoracoscopy combined with laparoscopy in the General Hospital of People's Liberation Army. With the patients at a supine position, laparoscopy was performed to complete stomach mobilization and abdominal lymph node dissection. Thoracoscopy was then carried out with the patients lying on the left to mobilize the esophagus and dissect thoracic lymph nodes. Finally, the stomach was pulled into the thoracic cavity via the hiatus of the diaphragm to construct a tube-like stomach, which was then anastomosed to the esophagus using the OrVil system.

RESULTSNo patient was converted to open surgery during the operation. The total operative time ranged from 200 to 320 min. The mean laparoscopic time was 75(range, 45-90) min, and the mean thoracoscopic time 160(120-240) min. The mean intraoperative blood loss was 220(160-300) ml. The mean lymph node retrieval was 12(9-18). No anastomotic fistula, chylothorax, lung infection were found postoperatively.

CONCLUSIONAfter esophageal resection using single-port thoracoscopic and laparoscopy, reconstruction using OrVil system is safe and feasible.

Aged ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Thoracoscopy ; methods

Minimally invasive surgery is now rapidly developing and becoming a standard surgical option in some fields. In the past, many thoracic surgeons were reluctant to adopt minimally invasive techniques in esophageal cancer surgery due to concern over the oncologic perspectives and technical difficulties. However, over the last few years, thoracic surgeons have progressively embraced the technical advancements and now many experienced centers have adopt minimally invasive surgery as a primary option for non-advanced esophageal cancer operations. In esophageal cancer surgery, the volume of operation performed in some hospital is closely related to the outcome of patients, and the experiences of surgical team play an important role in minimally invasive surgery. Minimally invasive esophageal surgery (MIES) has steep learning curves, also. The merits of MIES are as follows. The conventional esophageal cancer operation has two or triple incisions, resulting in high postoperative morbidity and mortality. However, postoperative complication in MIES became less frequent than conventional surgery. The patient's satisfaction is high. Mid-term outcomes of MIES have been reported that it is safe and feasible in esophageal cancer and survival curves are similar to those of conventional surgery. Therefore, MIES is a valuable therapeutic modality for both esophageal cancer patients and thoracic surgeons.
Esophageal Neoplasms/*surgery ; Humans ; Laparoscopy/methods ; Surgical Procedures, Minimally Invasive/methods ; Thoracoscopy/methods

The use of anterior surgical techniques for the treatment of adolescent idiopathic scoliosis (AIS) has increased recently and anterior discectomy, anterior release and fusion, instrumentation of the thoracic scoliosis can be performed through a thoracoscopic approach. The thoracoscopic approach has several advantages: small surgical trauma, early return to work, reduced postoperative pain and improved postoperative respiratory functions. Although the thoracoscopic approach still has some shortcomings currently, it will be widely accepted with further development of this technique and instrumentations in the future.
Adolescent ; Animals ; Diskectomy ; methods ; Humans ; Internal Fixators ; Scoliosis ; surgery ; Spinal Fusion ; methods ; Thoracic Vertebrae ; surgery ; Thoracoscopy ; methods ; Thoracotomy ; methods

INTRODUCTIONMinimally invasive surgical ablation is an emerging alternative method to catheter ablation and the full surgical maze procedure for nonpharmacologic treatment of atrial fibrillation (AF). We present a totally thoracoscopic "box lesion" radiofrequency ablation procedure in patients with paroxysmal or persistent AF.

MATERIALS AND METHODSFrom June 2011 to October 2012, 14 patients with lone paroxysmal (n = 7) or persistent AF (n = 7) were enrolled in this study. Procedures were performed through 3 5-12 mm holes on each side of the chest wall. A bipolar ablation device was used to create a box lesion in the posterior wall of the left atrium that encircled the 4 pulmonary veins (achieving bilateral pulmonary vein/posterior left atrial wall isolation). Perioperative complications were recorded for all patients. Freedom from AF was assessed by 24-hour Holter monitoring every 3 months or during symptoms of arrhythmia.

RESULTSThe ablation was successfully performed in all patients, with median operation time of 128 minutes (range, 45 to 180 minutes). No operative mortality or morbidity were noted during the study period. Freedom from AF was achieved in 12 patients (85.7%) during follow-up (median follow-up 9 months). One patient with persistent AF was shifted to paroxysmal AF. No atrial flutter or atrial tachycardia was noted during the follow-up.

CONCLUSIONThese early results show that totally thoracoscopic surgical ablation using a unique "box lesion" procedure for persistent or paroxysmal AF is a feasible and effective method with good short-term results. Further study is necessary to validate this result.

Adult ; Aged ; Atrial Fibrillation ; surgery ; Catheter Ablation ; methods ; Female ; Humans ; Male ; Middle Aged ; Thoracoscopy

OBJECTIVETo investigate the feasibility and safety of minimally invasive esophagectomy (MIE) for esophageal carcinoma.

METHODSClinical data of 298 esophageal carcinoma cases who were treated by MIE in the Fujian Provincial Cancer Hospital from June 2008 to April 2012 were retrospectively reviewed.

RESULTSAll the patients underwent MIE successfully except one conversion to open surgery. The mean operative time was (242.3±58.7) min. The postoperative length of hospital stay was (17.4±9.8) d. The number of harvested lymph nodes of total, the mediastinum, the abdomen and the cervix was 27.5±12.2, 10.7±5.7, 13.3±7.8, and 7.7±8.1, respectively. Postoperative complication rate was 29.9%, including pneumonia (n=41), recurrent laryngeal nerve injury (n=25), anastomotic leak (n=9), wound infection (n=7), and others (n=7). After follow up of 2 to 47 months, 3 patients were found to develop anastomotic stricture. There were no recurrence, metastasis, or death.

CONCLUSIONMinimally invasive esophagectomy is a safe, feasible, effective and minimally invasive surgical technique.

Adult ; Aged ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Thoracoscopy

OBJECTIVETo explore the feasibility, safety and clinical application value of minimally invasive esophagectomy (MIE).

METHODSClinical data of 160 patients undergoing minimally invasive approach in the West China Hospital of Sichuan University between February 2008 and December 2011 were analyzed retrospectively.

RESULTSThere were 140 males and 20 females with a mean age of 59.6 years. Approaches to esophagectomy were thoracoscopic and laparoscopic esophagectomy (n=139), thoracoscopic and mediastinoscopic esophagectomy (n=3), laparoscopic-assisted Ivor Lewis resection (n=15), thoraco-laparoscopic Ivor Lewis resection (n=3). The mean operative time was 364 (range 230-780) min and the mean blood loss was 286.2 (range 20 to 4000) ml. The tumor free resection margins (R0) were completely in 152 cases (95.0%). The mean lymph node harvested was 19.4 (range 6-39). There were 11 (6.9%) cases converted to open operation including 9 thoracotomy and 2 laparotomy. The intraoperative complication rate was 11.3% (18/160). The average length of intensive care unit (ICU) stay was 22.1(range 0 to 430) h and the average length of postoperative hospital stay was 13.1 (range 7-93 d). Postoperative complication occurred in 34.4% of patients. The 30-day mortality was 1.2% (2/160) and the overall mortality was 2.5% (4/160).

CONCLUSIONMIE is technically feasible and safe for the treatment of esophageal carcinoma, which provides good or even better outcomes than open approach.

Adult ; Aged ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Thoracoscopy

Along with continuous improvement of clinical staging modalities and endoscopic instrument and skills, the staging-based minimally invasive treatment for esophageal carcinoma has been firmly guaranteed, because of more accurate pretreatment staging and more mature minimally invasive technique. Different minimally invasive treatment should be provided to patients with different stage. On the premise of assurance of treatment, it would minimize trauma, accelerate rehabilitation, and improve quality of life.
Endosonography ; Esophageal Neoplasms ; pathology ; surgery ; Humans ; Minimally Invasive Surgical Procedures ; methods ; Neoplasm Staging ; Thoracoscopy