THELDENIYA THORACOSCOPIC ESOPHAGECTOMY; NEW TECHNIQUE USING THE ENDOSCOPE ONLY, INSTEAD OF THE LAPAROSCOPE kosala.medi@gmail.com

PW02-04

THELDENIYA THORACOSCOPIC ESOPHAGECTOMY; NEW TECHNIQUE USING THE ENDOSCOPE ONLY, INSTEAD OF THE LAPAROSCOPE

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Prabodha Iddamalgoda prabo7.pi@gmail.com District Base Hospital Surgery Theldeniya Sri Lanka

Vishwanath Thennakoon vishaath@gmail.com District Base Hospital Surgery Theldeniya Sri Lanka

 

 

Sri Lanka

Oral or Poster

Thoracoscopic esophagectomy is the current standards of care for operative management of esophageal cancer. Laparoscopy setup is the basic minimum requirement for this. Here we present a new technique of doing thoracoscopic esophagectomy in a center where laparoscopy setup is not available.

A 67 year old healthy lady presented with progressive dysphagia. Upper GI endoscopy revealed a mid-esophageal growth. Histopathology revealed a squamous carcinoma. After CE/CT in MDT discussion it was decided to do surgery and adjuvant chemo-radiotherapy. Under general anesthesia with single lung ventilation and semi-prone position the port positioning was as for standard thoracoscopic esophagectomy. Through the camera port the upper GI endoscope was introduced. The endoscope was handled by an experienced endoscopist, thus giving the necessary view for the operating surgeon. Dissections done using standard laparoscopic instruments and techniques using the LigasureR as the energy platform. Esophagectomy was done in an Azygos preserving dissection and specimen delivered through abdominal incision. Reconstruction done using a gastric conduit with a cervical anastomosis. Patient recovered well with no complications and adjuvant chemotherapy only was given without radiotherapy as the resection margins were good.

This novel technique shows that a surgeon with necessary laparoscopic skills can do a successful thoracoscopic dissection with the view offered by the endoscope. Though the visuals are inferior to the standard laparoscope the higher maneuverability of endoscope and the skill of the endoscopist circumvent the technical issues.

Innovation and skills in minimally invasive surgery (MIS) can compensate for technology, and excellent outcomes can still be achieved.