title: Thoracoscopic esophagectomy in the prone position.
abstract: BACKGROUND
  Minimally invasive esophageal surgery has arisen in an attempt to reduce the significant complications associated with esophagectomy. Despite proposed technical and physiological advantages, the prone position technique has not been widely adopted. This article reviews the current status of prone thoracoscopic esophagectomy.
  
  
  METHODS
  A systematic literature search was performed to identify all published clinical studies related to prone esophagectomy. Medline, EMBASE and Google Scholar were searched using the keywords "prone," "thoracoscopic," and "esophagectomy" to identify articles published between January 1994 and September 2010. A critical review of these studies is given, and where appropriate the technique is compared to the more traditional minimally invasive technique utilising the left lateral decubitus position.
  
  
  RESULTS
  Twelve articles reporting the outcomes following prone thoracoscopic oesophagectomy were tabulated. These studies were all non-randomised single-centre prospective or retrospective studies of which four compared the technique to traditional minimally invasive surgery. Although prone esophagectomy is demonstrated as being both feasible and safe, there is no convincing evidence that it is superior to other forms of esophageal surgery. Most authors comment that the prone position is associated with superior surgical ergonomics and theoretically offers a number of physiological benefits.
  
  
  CONCLUSIONS
  The ideal approach within minimally invasive esophageal surgery continues to be a subject of debate since no single method has produced outstanding results. Further clinical studies are required to see whether ergonomic advantages of the prone position can be translated into improved patient outcomes.
authors.affiliation: Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College London, Praed Street, London, W2 1NY, UK.
authors.forename: Omar A
authors.initials: OA
authors.lastname: Jarral
authors.forename: Sanjay
authors.initials: S
authors.lastname: Purkayastha
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: George B
authors.initials: GB
authors.lastname: Hanna
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Zacharakis
mesh_terms: D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods; D016684:Prone Position; D011446:Prospective Studies; D012143:Respiratory Physiological Phenomena; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome