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Thoracoscopic esophagectomy for esophageal cancer: feasibility and safety of robotic assistance in the prone position.

Authors
 Dae Joon Kim  ;  Woo Jin Hyung  ;  Chang Young Lee  ;  Jin-Gu Lee  ;  Seok Jin Haam  ;  In-Kyu Park  ;  Kyung Young Chung 
Citation
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.139(1) : 53-1, 2010 
Journal Title
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 
ISSN
 0022-5223 
Issue Date
2010
MeSH
Esophageal Neoplasms/surgery ; Esophagectomy/methods* ; Feasibility Studies ; Female ; Hemodynamics/physiology ; Humans ; Male ; Middle Aged ; Postoperative Care ; Postoperative Complications ; Prone Position/physiology* ; Respiratory Physiological Phenomena ; Robotics* ; Thoracoscopy* ; Treatment Outcome
Abstract
OBJECTIVE: To assess the feasibility and safety of robot-assisted thoracoscopic esophagectomy for esophageal cancer in the prone position. METHODS: Twenty-one patients underwent robot-assisted thoracoscopic esophagectomy in the prone position by a surgical oncologist who had no prior experience with thoracoscopic esophagectomy. Hemodynamic and respiratory parameters were serially recorded to monitor changes in prone positioning. RESULTS: All thoracoscopic procedures were completed with a robot-assisted technique followed by cervical esophagogastrostomy. R0 resection was achieved in 20 patients (95.2%), and the number of dissected nodes was 38.0 + or - 14.2. Robot console time was significantly reduced from 176.3 + or - 12.3 minutes in the initial 6 patients (group 1) to 81.7 + or - 16.5 minutes in the latter 15 patients (group 2) (P = .000). In group 2, there was less blood loss (P = .018), more patients could be extubated in the operating room (P = .004), and the number of dissected mediastinal nodes tended to be increased (P = .093). There was no incidence of pneumonia or 90-day mortality. Major complications included anastomotic leakage in 4 patients, vocal cord palsy in 6 patients, and intra-abdominal bleeding in 1 patient. The prone position led to an elevation of central venous pressure and mean pulmonary arterial pressure and a decrease in static lung compliance. However, cardiac index and mean arterial pressure were well maintained with the acceptable range of partial pressure of arterial oxygen and carbon dioxide. CONCLUSION: Robotic assistance in the prone position is technically feasible and safe. Prone positioning was well tolerated, but preoperative risk assessment and meticulous anesthetic manipulation should be carried out.
Full Text
http://www.sciencedirect.com/science/article/pii/S0022522309008083
DOI
10.1016/j.jtcvs.2009.05.030
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dae Joon(김대준)
Park, In Kyu(박인규)
Lee, Jin Gu(이진구)
Lee, Chang Young(이창영)
Chung, Kyung Young(정경영)
Haam, Seok Jin(함석진)
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/100419
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