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Rajan S, Akhtar N, Kumar V, Arya S, Tiwari T, Kannojiya DP. Uniportal video-assisted thoracoscopic surgery in semi-prone position utilising direct endobronchial intubation for oesophagus leiomyoma excision. J Minim Access Surg 2023; 19:172-174. [PMID: 36722544 PMCID: PMC10034812 DOI: 10.4103/jmas.jmas_43_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Leiomyomas are the most common benign tumours of oesophageal smooth muscle origin. In this era of constantly evolving medical technology, video-assisted, robot-assisted and endoscopic approaches are the minimally invasive strategies for the excision of these lesions. Here, we report our modification of this surgery. The lesion was excised with uniportal video-assisted thoracoscopic surgery in a semi-prone position with single-lumen endobronchial intubation.
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Affiliation(s)
- Shiv Rajan
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Naseem Akhtar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vijay Kumar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sugandha Arya
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tanmay Tiwari
- Department of Anesthesia, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Durga Prasad Kannojiya
- Department of Anesthesia, King George's Medical University, Lucknow, Uttar Pradesh, India
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2
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Nachira D, Congedo MT, Calabrese G, Tabacco D, Petracca Ciavarella L, Meacci E, Vita ML, Punzo G, Lococo F, Raveglia F, Chiappetta M, Porziella V, Guttadauro A, Cioffi U, Margaritora S. Uniportal-VATS vs. open McKeown esophagectomy: Surgical and long-term oncological outcomes. Front Surg 2023; 10:1103101. [PMID: 36923380 PMCID: PMC10008900 DOI: 10.3389/fsurg.2023.1103101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023] Open
Abstract
Background Till now there are very few reports about surgical results of Uniportal-VATS esophagectomy and no one about long-term outcomes. This study is the first comparing surgical and oncological outcomes of Uniportal-VATS with open McKeown esophagectomy, with the largest reported series and longest oncological follow-up. Methods The prospectively collected clinical, surgical and oncological data of 75 patients, undergone McKeown esophagectomy at our Thoracic Surgery Department, from January 2012 to August 2022, were retrospectively analyzed. Nineteen patients underwent esophagectomy by thoracotomy and reconstruction according to McKeown technique while 56 by Uniportal-VATS approach. Gastric tubulization was performed totally laparoscopic or through a mini-laparatomic access and cervical anastomosis was made according to Orringer's technique. Results The mean operative thoracic time was similar in both accesses (102.34 ± 15.21 min in Uniportal-VATS vs. 115.56 ± 23.12 min in open, p: 0.646), with a comparable number of mediastinal nodes retrieved (Uniportal-VATS:13.40 ± 8.12 vs. open:15.00 ± 6.86, p: 0.275). No case needed conversion from VATS to open. The learning curve in Uniportal-VATS was completed after 34 cases, while the Mastery was reached after 40. Both approaches were comparable in terms of minor post-operative complications (like pneumonia, lung atelectasis, anemization, atrial fibrillation, anastomotic-leak, left vocal cord palsy, chylothorax), while the number of re-operation for major complications (bleeding or mediastinitis) was higher in open group (21.0% vs. 3.6%, p: 0.04). Both techniques were also effective in terms of surgical radicality and local recurrence but VATS approach allowed a significantly lower chest tube length (11.89 ± 9.55 vs. 25.82 ± 24.37 days, p: 0.003) and post-operative stay (15.63 ± 11.69 vs. 25.53 ± 23.33, p: 0.018). The 30-day mortality for complications related to surgery was higher in open group (p: 0.002). The 2-, 5- and 8-year survival of the whole series was 72%, 50% and 33%, respectively. Combined 2- and 5-year OS in Uniportal-VATS group was 76% and 47% vs. 62% and 62% in open group, respectively (Log-rank, p: 0.286; Breslow-Wilcoxon: p: 0.036). No difference in DFS was recorded between the two approaches (5 year-DFS in Uniportal-VATS: 86% vs. 72%, p: 0.298). At multivariate analysis, only pathological stage independently affected OS (p: 0.02), not the surgical approach (p: 0.276). Conclusions Uniportal-VATS seems to be a safe, feasible and effective technique for performing McKeown esophagectomy, with equivalent surgical and long-term oncological results to standard thoracotomy, but with a faster and unharmed recovery, and a quite short learning curve.
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Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Calabrese
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diomira Tabacco
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Leonardo Petracca Ciavarella
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Punzo
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Lococo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federico Raveglia
- Department of Thoracic Surgery, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Marco Chiappetta
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Venanzio Porziella
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery- School of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Milan, Italy
| | - Ugo Cioffi
- Doctorate Professor, University of Milan, Milan, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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3
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Cerfolio RJ, Laliberte AS, Blackmon S, Ruurda JP, Hillegersberg RV, Sarkaria I, Louie BE. Minimally Invasive Esophagectomy: A Consensus Statement. Ann Thorac Surg 2020; 110:1417-1426. [PMID: 32213311 DOI: 10.1016/j.athoracsur.2020.02.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Minimally invasive esophagectomy (MIE) is increasingly performed in various ways. The lack of international definitions and nomenclature makes accurate comparison of outcomes difficult. METHODS An international, multispecialty consensus-writing committee constructed definitions and nomenclature for MIE. After a PubMed search, vetting, and review with all authors, a consensus was reached. RESULTS The proposed definition for MIE is an operation "that removes part or all of the esophagus, does not retract, lift, spread or remove any part of the chest or abdominal wall and the surgeon's and assistant's vision of the operative field is via a monitor, the patient's tissue is manipulated only by instruments that are controlled by the operating surgeon or team, except for during the neck portion if used." A flexible nomenclature is proposed that attempts to describe current and future operations and systems. CONCLUSIONS Definitions and nomenclature for MIE are needed to ensure that future studies accurately compare results and outcomes of similar operations. Nomenclatures allow surgeons, researchers, and patients from different cultures to use a common language to facilitate communication and compare. This process is required in order to improve patient outcomes globally to drive adoption of best of practice, yet is lacking for MIE.
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Affiliation(s)
- Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
| | - Anne-Sophie Laliberte
- Department of General Surgery, Centre Hospitalier Affilié Universitaire de Québec (CHA), Quebec, Canada
| | - Shanda Blackmon
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Inderpal Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Brian E Louie
- Department of Thoracic Surgery, Swedish Medical Center, Seattle, Washington
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4
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Zhang Z, Rong B, Guo M. Uniportal Thoracoscopic McKeown Esophagectomy. Indian J Surg 2020; 82:669-671. [PMID: 32419746 PMCID: PMC7223588 DOI: 10.1007/s12262-020-02096-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 02/07/2020] [Indexed: 10/26/2022] Open
Abstract
We performed the technique of uniportal thoracoscopic McKeown esophagectomy. The incision was located in the fourth intercostal space on the right axillary midline. The right recurrent laryngeal nerve lymph nodes were dissected. Four hemlocks were applied to clamp the proximal and distal ends of the aortic arch. The esophagus was suspended with purse-string at the level of the azygos vein arch to assist the dissection of the left recurrent laryngeal nerve lymph nodes. A silk thread was drawn out from the incision in order to remove the subcarinal lymph nodes. A thoracic drainage tube was placed at the back of the incision at the end.
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Affiliation(s)
- Zhenghua Zhang
- 1Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, Anhui 230001 People's Republic of China
| | - Baolin Rong
- 1Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, Anhui 230001 People's Republic of China
| | - Mingfa Guo
- 1Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, Anhui 230001 People's Republic of China.,Heifei, People's Republic of China
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5
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Soultanis KM, Gonzalez-Rivas D. Devising the guidelines: the concept of uniportal video-assisted thoracoscopic surgery-incisions and anesthetic management. J Thorac Dis 2019; 11:S2053-S2061. [PMID: 31637038 DOI: 10.21037/jtd.2019.02.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Uniportal video-assisted thoracoscopic surgery (VATS) is an already established minimally invasive technique in the field of thoracic surgery. The feasibility, safety and efficacy of the technique are already well documented. Comparative studies and meta-analyses have shown a clear advantage over open surgery and other minimally invasive techniques in terms of pain, length of stay (LOS), chest drain duration and morbidity. It covers a broad spectrum of indications for both malignant and benign diseases, including pulmonary and mediastinal tumor resections, diaphragm procedures (plication), esophageal surgery and airway surgery (bronchial resections, carinal resections). Its swift and wide adoption has resulted into many variations, all of whom are common in the fact they utilize a single incision to enter the chest and conduct the planned procedure. With this article, we attempt to standardize the technique as to the incision and the anesthetic management.
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Affiliation(s)
- Konstantinos Marios Soultanis
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai 200433, China.,Thoracic Surgery Department, Hellenic Airforce General Hospital, Athens, Greece
| | - Diego Gonzalez-Rivas
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai 200433, China.,Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
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Abstract
Purpose of review The current review focuses on precise anesthesia for video-assisted thoracoscopic surgery (VATS) with the goal of enhanced recovery. Recent findings VATS has become an established and widely used minimally invasive approach with broad implementation on a variety of thoracic operations. In the current environment of enhanced recovery protocols and cost containment, minimally invasive VATS operations suggest adoption of individualized tailored, precise anesthesia. In addition to a perfect lung collapse for surgical interventions with adequate oxygenation during one lung ventilation, anesthesia goals include a rapid, complete recovery with adequate postoperative analgesia leading to early discharge and minimized costs related to postoperative inpatient services. The components and decisions related to precise anesthesia are reviewed and discussed including: letting patients remain awake versus general anesthesia, whether the patient should be intubated or not, operating with or without muscle relaxation, whether to use different separation devises, operating with different local and regional blocks and monitors. Conclusion The determining factors in designing a precise anesthesic for VATS operations involve consensus on patients’ tolerance of the associated side effects, the best practice or techniques for surgery and anesthesia, the required postoperative support, and the care team's experience.
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Shao J, Xiao T, Shi M, Zhou X, Wang Z, Lin T, Xu R, Ni H, Zhang A. Effect of multimedia-based nursing visit on perioperative anxiety in esophageal squamous cell carcinoma patients undergoing video-assisted thoracoscopic surgery. PSYCHOL HEALTH MED 2019; 24:1198-1206. [PMID: 30907130 DOI: 10.1080/13548506.2019.1595687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jingjing Shao
- Department of Nursing, The Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Ting Xiao
- Department of Nursing, The Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Minxin Shi
- Department of Thoracic Surgery, The Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Xiaomei Zhou
- Department of Nursing, The Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Zhiwei Wang
- Department of Breast, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tianlong Lin
- Department of Thoracic Surgery, Shanghai Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongfang Xu
- Department of Nursing, The Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Hongxia Ni
- Department of Nursing, The Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Aihua Zhang
- Department of Nursing, The Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China
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8
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Nachira D, Meacci E, Mastromarino MG, Pogliani L, Zanfrini E, Iaffaldano A, Petracca-Ciavarella L, Chiappetta M, Congedo MT, Vita ML, Porziella V, Margaritora S. Initial experience with uniportal video-assisted thoracic surgery esophagectomy. J Thorac Dis 2018; 10:S3686-S3695. [PMID: 30505553 DOI: 10.21037/jtd.2018.04.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Multiportal thoracoscopic approach is already a well standardized procedure for minimally invasive esophagectomy (MIE); conversely very few reports have been published about uniportal video-assisted thoracic surgery (VATS) technique till now. We present our preliminary experience with uniportal VATS esophagectomy, evaluating short-term outcomes as perioperative mortality, complications, oncological radicality, postoperative pain and cosmetic results. Methods From December 2016 to November 2017, the prospectively collected clinical data of 12 patients, who underwent uniportal VATS esophagectomy and reconstruction with a stomach conduit, according to McKeown technique, were reviewed and outcomes evaluated. Results The mean age of population was 60.67±8.61 years. Ten (83.3%) patients were males. The main histological type was a squamous cell carcinoma in six patients (50%). No patient had a local recurrence. After 4.33±3.31 months 10 patients (83.3%) were alive with no evidence of disease; 2 (16.7%) patients died of other causes. Two (16.7%) patients developed an anastomotic leak (treated conservatively) and one (8.3%) patient a chylothorax (which required a surgical treatment). The mean operative time of uniportal VATS esophagectomy was 104.67±20.66 min. Mean number of thoracic nodes removed was 10.44±3.94. Post-operative hospitalization was 15.73±14.29 days (median of 9 days). The mean level of pain was 1.92±0.90 in first postoperative day with a duration of 2.25±1.54 days. Cosmetic result was 2.42±0.79 on a 3-point scale. Conclusions Uniportal VATS esophagectomy seems to be a safe, feasible and effective alternative to multiportal VATS in terms of operative time, postoperative mortality, hospital stay and oncological outcomes. Less postoperative pain and better cosmetic results seem to be some advantages in favor of Uniportal VATS, however further studies with longer follow-up are claimed.
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Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Elisa Meacci
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Maria Giovanna Mastromarino
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Luca Pogliani
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Edoardo Zanfrini
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Amedeo Iaffaldano
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Leonardo Petracca-Ciavarella
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Marco Chiappetta
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Venanzio Porziella
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
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Guido-Guerrero W, Bolaños-Cubillo A, González-Rivas D. Single-port video-assisted thoracic surgery (VATS)-advanced procedures & update. J Thorac Dis 2018; 10:S1652-S1661. [PMID: 30034831 DOI: 10.21037/jtd.2018.05.43] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The uniportal approach for major pulmonary resections began in 2010, with the first case being reported by D González-Rivas and colleagues in La Coruña, Spain. Since then, in different countries, thoracic surgeons had been performing hundreds of cases, with more advanced and complex procedures. Nowadays, there are reports of uniportal tracheal resection and reconstruction, carinal resection, bronchoplastic procedures, lobectomies with en bloc chest wall excision, and vascular reconstruction with optimal outcomes. The development of technologies and the potential benefits of a direct view, anatomic instrumentation, better cosmesis, and, potentially, less postoperative pain have led uniportal video-assisted thoracic surgery to grow exponentially worldwide.
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Affiliation(s)
- William Guido-Guerrero
- Department of Thoracic Surgery, Rafael Angel Calderón Guardia Hospital, San José, Costa Rica
| | - Albert Bolaños-Cubillo
- Department of Thoracic Surgery, Rafael Angel Calderón Guardia Hospital, San José, Costa Rica
| | - Diego González-Rivas
- Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Lerut T. Uniportal video-assisted thoracoscopic surgery in esophageal diseases: an introduction. J Vis Surg 2018; 3:182. [PMID: 29302458 DOI: 10.21037/jovs.2017.11.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/06/2017] [Indexed: 11/06/2022]
Abstract
Esophagectomy followed by reconstruction is one of the most complex interventions in surgery of the alimentary tract. Over several decennia dedicated surgeons have realized a constant decrease in 30-day mortality being now well below 5% in expert hands. However quality of life after such intervention is often jeopardized by the high incidence of complications in particular pulmonary infections. The introduction and presently widespread use of total minimally invasive esophagectomy (MIE) has re resulted in a substantial decrease of these pulmonary complications along with a decrease of the need for ICU admission and a decrease of length of hospital stay. But still a non-negligible share of patients may suffer from, sometimes severe, posthoracotomy pain. A problem that is thought to be the result of the manipulation of instruments at the port sites causing damage to the intercostal nerves. The growing popularity of uniportal video-assisted thoracoscopic surgery (VATS) in particular in lung surgery claims to diminish this problem. Currently there is little experience in the use of uniportal VATS for esophagectomy which seems to be in part related to its higher degree of technical complexity. As a result there are no published data on the results but there are a few dedicated centers that are building up their experience. Their preliminary results seem to hold promising perspectives in relation to overcome the pain problem using a single small port site. Future will tell what the place will be of uniportal VATS versus other techniques e.g., robotic esophagectomy, endoscopic interventions on the esophagus and new emerging avenues in molecular biology.
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Affiliation(s)
- Toni Lerut
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
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