Combined thoracoscopic and endoscopic management of mid-esophageal benign lesions: use of the prone patient position : Thoracoscopic surgery for mid-esophageal benign tumors and diverticula.
BACKGROUND
Both benign tumors and mid-esophageal diverticula are rare conditions; underlying disorders may be present in case of diverticula. Traditionally, thoracotomy was the preferred route to approach these lesions. Now, more surgeons are using minimally invasive techniques to treat these benign mid-esophageal lesions.


METHODS
A total of 12 patients with symptomatic mid-esophageal lesions were studied, benign tumors were seven cases and five cases of diverticula. We present our experiences with thoracoscopic enucleation of benign tumors and diverticulectomy aided by peroperative endoscopy. All the patients were placed in the prone position and approached via a right thoracotomy.


RESULTS
Two patients had minor complications of pneumonitis and dysphagia, which were treated conservatively. One patient had a leak from the staple line that needed a second-look thoracoscopy and evacuation of abscess.


CONCLUSIONS
In this study, we highlight the use of the prone patient position, the advantages of a right thoracoscopic approach and the value of peroperative endoscopy. The prone position was first described in 1994, but has not been popular. Peroperative endoscopy accurately localizes diverticula and determines level of stapler application.


CONCLUSIONS
Thoracoscopy has definite benefits regarding reduced morbidity. The combined modality of peroperative endoscopy is useful in diverticulectomy. Based on our experience, we believe the prone patient position is the ideal position for esophageal surgery.
Palanivelu
Chinnusamy
C
GEM Hospital, 45-A, Pankaja Mill Road, Ramnathapuram, Coimbatore, 641045, India.
Rangarajan
Muthukumaran
M
Senthilkumar
Rangasamy
R
Velusamy
Madhupalayam
M
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004936:Diverticulum, Esophageal / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D016684:Prone Position; D012189:Retrospective Studies; D018570:Risk Assessment; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome