370. LOWER MEDIASTINUM DISSECTION IN THORACOSCOPIC ESOPHAGECTOMY

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Diseases of the Esophagus Pub Date : 2024-09-02 DOI:10.1093/dote/doae057.129

Beatriz Pereira Gonçalves, Maria do Carmo Girão, Beatriz Chumbinho, Leonor Ávila, Francisco Cabral, Paulo Ramos, Cecília Monteiro, Rui Casaca, Nuno Abecasis

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Abstract

Background Thoracic esophagectomy is currently the preferred technique for the thoracic phase of transthoracic esophagectomy for esophageal cancer. Randomized controlled trials comparing this minimally invasive approach to the open one, demonstrated a lower rate of pulmonary complications rate, without worst long-term outcomes. Video-based learning of minimally invasive surgery is essential, especially in such a complex procedure like esophagectomy. However, resources are lacking. Therefore, we aim to conduct a video demonstration of lower mediastinum dissection of our standardized right thoracoscopy esophagectomy, in the prone position. Methods Surgery de-construction through video assessment is routinely performed in our upper gastrointestinal unit. It is fundamental for surgical training, as well as for technical skills improvement of experienced surgeons. Here we present a step-by-step approach of one of the key parts of our standardized thoracoscopic esophagectomy technique – the lower mediastinum dissection. Results Thoracoscopic esophagectomy is systematically performed in a prone position, using a bronchial blocker, 4 working ports and a pressure of 6 mmHg for pneumomediastinum. The first stage of thoracoscopic esophagectomy is the lower mediastinum dissection. Three main steps compose this procedure - posterior dissection, anterior dissection and main bronchus and carina dissection. This video offers a comprehensive overview of the key anatomical landmarks that require identification during the procedure, the sequential steps involved and the critical pitfalls. Conclusion Thoracoscopic esophagectomy for esophageal cancer should be performed in high-volume centers, in a standardized and systematic way. Video revision and procedure debriefing is essential not only for surgery learning and coaching, but also for outcome improvement. Sharing knowledge and experience through video-based presentations can contribute to development of this complex area of minimally invasive esophagectomy. https://drive.google.com/file/d/1vWJOTCey8wI6HQi0jAR8C_t3tUKVbrW1/view?usp=drive_link

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370.胸腔镜食管切除术中的下纵隔剥离术

背景胸腔食管切除术是目前经胸食管切除术胸腔阶段治疗食管癌的首选技术。随机对照试验比较了这种微创方法和开放式方法，结果显示肺部并发症发生率较低，但长期疗效并不差。微创手术的视频学习至关重要，尤其是像食管切除术这样复杂的手术。然而，目前缺乏这方面的资源。因此，我们的目标是在俯卧位进行标准化右胸腔镜食管切除术的下纵隔解剖视频演示。方法通过视频评估进行手术解剖是我们上消化道科的常规做法。这是外科培训的基础，也是经验丰富的外科医生提高技术技能的基础。在此，我们将逐步介绍我们的标准化胸腔镜食管切除术技术的关键部分之一--下纵隔解剖。结果胸腔镜食管切除术是在俯卧位、使用支气管阻断器、4 个工作孔和 6 mmHg 的气腹压力下系统进行的。胸腔镜食管切除术的第一阶段是下纵隔解剖。该手术有三个主要步骤：后部解剖、前部解剖以及主支气管和心管解剖。本视频全面介绍了手术过程中需要识别的关键解剖标志、所涉及的顺序步骤和关键陷阱。结论食管癌胸腔镜食管切除术应在大容量中心以标准化和系统化的方式进行。视频修改和手术汇报不仅对手术学习和指导至关重要，对改善手术效果也很重要。通过视频演示分享知识和经验有助于微创食管切除术这一复杂领域的发展。https://drive.google.com/file/d/1vWJOTCey8wI6HQi0jAR8C_t3tUKVbrW1/view?usp=drive_link。

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