1
|
Mishra S, Jain N, Soni B, Bajaj D, Khetan A, Sharma B, Bhojwani R. Thoracoscopic enucleation of oesophageal submucosal tumours in prone position gives excellent long-term outcome: A single-centre experience. J Minim Access Surg 2021; 18:401-407. [PMID: 35046167 PMCID: PMC9306123 DOI: 10.4103/jmas.jmas_169_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Thoracoscopic enucleation of oesophageal leiomyomas has been adopted by many centres. The procedure when performed in prone position gives good results. The long-term outcome has not been reported earlier. This single-centre study establishes the role of this particular technique. Methods: A retrospective analysis of a prospectively maintained hospital database was performed and after following the study criteria eleven cases of oesophageal submucosal tumours were included in the study. All patients underwent thoracoscopic enucleation in the prone position by a single surgeon. Peri-operative data were recorded and patients followed up for a mean period of 78 months (range = 24–120 months). Results: Thoracoscopic enucleation in prone position was done for all patients with no conversions to an open procedure. Two patients had a mucosal rent during dissection that was repaired. There was no post-operative morbidity greater than Clavien-Dindo Grade 2. Long-term follow-up is available for eight patients (73%) with no recurrence of disease or symptoms. Conclusion: Oesophageal submucosal tumours (predominantly leiomyomas) are benign neoplasms with an indolent biological behaviour and deserve a procedure that would serve the purpose of minimal post-operative morbidity coupled with excellent outcome. Thoracoscopic enucleation in the prone position provides a physiological benefit that translates into better peri-operative outcomes without compromising the long-term outcome and should be the preferred form of treatment for oesophageal submucosal tumours.
Collapse
Affiliation(s)
- Siddharth Mishra
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Durlabhji Memorial Hospital and Medical Research Centre, Santokba Institute of Digestive Surgical Sciences, Jaipur, Rajasthan, India
| | - Nikhil Jain
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Durlabhji Memorial Hospital and Medical Research Centre, Santokba Institute of Digestive Surgical Sciences, Jaipur, Rajasthan, India
| | - Bansidhar Soni
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Durlabhji Memorial Hospital and Medical Research Centre, Santokba Institute of Digestive Surgical Sciences, Jaipur, Rajasthan, India
| | - Deepak Bajaj
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Durlabhji Memorial Hospital and Medical Research Centre, Santokba Institute of Digestive Surgical Sciences, Jaipur, Rajasthan, India
| | - Ashish Khetan
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Durlabhji Memorial Hospital and Medical Research Centre, Santokba Institute of Digestive Surgical Sciences, Jaipur, Rajasthan, India
| | - Bhuwanesh Sharma
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Durlabhji Memorial Hospital and Medical Research Centre, Santokba Institute of Digestive Surgical Sciences, Jaipur, Rajasthan, India
| | - Rajesh Bhojwani
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Durlabhji Memorial Hospital and Medical Research Centre, Santokba Institute of Digestive Surgical Sciences, Jaipur, Rajasthan, India
| |
Collapse
|
2
|
Kemuriyama K, Motoyama S, Sato Y, Wakita A, Nagaki Y, Fujita H, Sasamori R, Imai K, Aokawa M, Minamiya Y. Robot-assisted thoracoscopic enucleation for a large esophageal leiomyoma: a case report. Surg Case Rep 2021; 7:129. [PMID: 34037886 PMCID: PMC8155148 DOI: 10.1186/s40792-021-01212-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022] Open
Abstract
Background Video-assisted thoracoscopic surgery (VATS) is being used to treat esophageal submucosal tumors (SMTs) all over the world. However, this technique is difficult when the tumor is large and located on the left side wall of the esophagus, within the upper mediastinum. This is because, with VATS, the surgical forceps have a limited range of motion. Robot-assisted thoracoscopic surgery (RATS) using the da Vinci surgical system may be extremely useful for enucleation of esophageal SMTs within the narrow upper mediastinum. Case presentation A female in her thirties experiencing epigastric pain visited our hospital and was diagnosed with a large esophageal leiomyoma within the upper mediastinum. From its size (10 cm), it was judged to have malignant potential. We performed SMT enucleation using RATS with a da Vinci surgical system Xi. This was our second case using this system. The patient was placed in the left lateral position. Four da Vinci trocars (8 mm) were inserted into the 10th, 7th, 5th and 3rd intercostal spaces (ICS), and an assist port was added in the 5th ICS. We opened the superior mediastinal pleura cranially and caudally from the arch of the azygos vein and expanded the superior mediastinum after dividing the azygos vein. We made an incision in the muscular layer of the esophagus and, using a monopolar hook and monopolar scissors, enucleated the esophageal tumor in a protective manner so as not to damage its capsule or mucosa while applying appropriate robot-specific counter traction. We then sewed up the muscularis using 4–0 Vicryl, inserting the endoscope into the thoracic esophagus to substitute for a bougie. In addition, the pleura was sutured using barbed suture. The surgical procedure was straightforward and smooth. The patient was discharged on postoperative day 4 with no surgical complications. The tumor was definitively diagnosed pathologically from paraffin sections as a benign esophageal leiomyoma. Conclusions RATS enables more delicate and precise esophageal SMT enucleation without surgical complications, though various challenges remain to be overcome. Supplementary Information The online version contains supplementary material available at 10.1186/s40792-021-01212-9.
Collapse
Affiliation(s)
- Kohei Kemuriyama
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Satoru Motoyama
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan. .,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan. .,Comprehensive Cancer Control, Akita University Graduate School of Medicine, Akita, Japan.
| | - Yusuke Sato
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Akiyuki Wakita
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yushi Nagaki
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiromu Fujita
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Ryohei Sasamori
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Imai
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Masaki Aokawa
- Gastroenterology, Noshiro Kousei Medical Center, Noshiro, Japan
| | - Yoshihiro Minamiya
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| |
Collapse
|
3
|
Ishii M, Takeno S, Nishida T, Nanashima A, Kubota Y, Kawakami H, Umekita Y, Akiyama Y. Thoracoscopic enucleation in the left decubitus position for leiomyoma of the upper thoracic esophagus: Utility of preoperative diagnosis applying endoscopic ultrasound-guided fine needle aspiration. Int J Surg Case Rep 2017; 34:49-55. [PMID: 28371632 PMCID: PMC5377431 DOI: 10.1016/j.ijscr.2017.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 12/21/2022] Open
Abstract
We report a case of esophageal leiomyoma enucleated by thoracoscopic procedures. Preoperative EUS-FNA is useful to decide the operative procedure. Preoperative EUS-FNA does not adversely influence subsequent enucleation. Precise preoperative diagnosis is necessary to avoid excessive surgery.
Introduction We report a relatively rare case of esophageal leiomyoma in the upper thoracic esophagus enucleated by thoracoscopic procedures. The usefulness of preoperative diagnosis and an adequate surgical approach are described along with a review of the relevant literature. Presentaion of case A submucosal tumor 45 mm in diameter was detected in the upper thoracic esophagus of a 69-year-old man. The tumor was preoperatively diagnosed from histopathological biopsy under endoscopic ultrasound-guided fine needle aspiration. Thoracoscopic enucleation was therefore preoperatively scheduled under the left decubitus position in consideration of the low risk of malignant disease. Histopathological diagnosis of the resected specimen was benign leiomyoma and patient outcomes were good. Discussion The need for preoperative biopsy of esophageal submucosal tumor is a controversial issue. However, preoperative biopsy provided the benefits to decide the operative procedure or confirm adequate resection, and our experience suggested that preoperative biopsy did not adversely influence subsequent enucleation. Conclusion Precise preoperative diagnosis is necessary to avoid excessive surgery when managing esophageal submucosal tumor.
Collapse
Affiliation(s)
- Mitsutoshi Ishii
- Division of Gastrointestinal, Endocrine and Pediatric Surgery in the Department of Surgery, Faculty of Medicine, University of Miyazaki.
| | - Shinsuke Takeno
- Division of Gastrointestinal, Endocrine and Pediatric Surgery in the Department of Surgery, Faculty of Medicine, University of Miyazaki; Division of Endoscopy, University of Miyazaki Hospital
| | - Takahiro Nishida
- Division of Gastrointestinal, Endocrine and Pediatric Surgery in the Department of Surgery, Faculty of Medicine, University of Miyazaki; Division of Endoscopy, University of Miyazaki Hospital
| | - Atsushi Nanashima
- Division of Endoscopy, University of Miyazaki Hospital; Division of Hepato-biliary-pancreas Surgery in the Department of Surgery, Faculty of Medicine, University of Miyazaki
| | - Yoshimasa Kubota
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Miyazaki; Center for Digestive Disease, University of Miyazaki Hospital
| | - Hiroshi Kawakami
- Division of Endoscopy, University of Miyazaki Hospital; Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Miyazaki; Center for Digestive Disease, University of Miyazaki Hospital
| | - Yoshiko Umekita
- Department of Clinical Laboratory, Faculty of Medicine, University of Miyazaki
| | - Yutaka Akiyama
- Department of Diagnostic Pathology, University of Miyazaki Hospital, Kihara 5200, Kiyotake-cho, Miyazaki City, Miyazaki 889-1692, Japan
| |
Collapse
|