title: Prone thoracoscopic esophageal mobilization for minimally invasive esophagectomy.
abstract: BACKGROUND
  Minimally invasive esophagectomy is a complex surgical procedure. We recently began performing thoracic mobilization of the esophagus with the patient in the prone position, not the left lateral decubitus position, in the hope of minimizing the number of technical challenges.
  
  
  METHODS
  Six consecutive minimally invasive esophagectomies were performed using prone thoracoscopic esophageal mobilization with creation of cervical anastamosis. Our esophagectomy database was evaluated for outcomes, including operative time, estimated blood loss, complications, and length of hospital stay.
  
  
  RESULTS
  We were successful in our first six attempts, with a mean blood loss of 61 cc. Mean operative time for thoracoscopy was 80 min. Operative times were steady over the first six prone cases at 105, 85, 70, 55, 80, and 85 min. Three of the six patients had no complications. Median postoperative length of hospital stay was 11.5 days, and there were no deaths.
  
  
  CONCLUSIONS
  This technical report and case series demonstrates that prone thoracoscopic esophageal mobilization appears to be a reasonable alternative to the same procedure performed with the patient in the decubitus position. We find the technique to simplify portions of an otherwise difficult surgical procedure. Further evaluation with larger number of patients should be performed.
authors.affiliation: Department of Surgery, Hospital of St. Raphael, 330 Orchard Street, Suite 300, New Haven, Connecticut 06512, USA. tfabs@yahoo.com
authors.forename: T
authors.initials: T
authors.lastname: Fabian
authors.forename: A A
authors.initials: AA
authors.lastname: McKelvey
authors.forename: M S
authors.initials: MS
authors.lastname: Kent
authors.forename: J A
authors.initials: JA
authors.lastname: Federico
mesh_terms: D000328:Adult; D000368:Aged; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D013906:Thoracoscopy / Q000379:methods*