title: Assistant-based standardization of prone position thoracoscopic esophagectomy.
abstract: Thoracoscopic esophagectomy in the prone position (TEPP) might enable solo-surgery in cases requiring resection of the esophagus and the surrounding lymph nodes due to the associated advantages of good exposure of the surgical field and ergonomic considerations for the surgeon. However, no one approach can be for all patients requiring extensive lymphadenectomy. We recently developed an assistant-based procedure to standardize exposure of the surgical field. Patients were divided into 1 of 2 groups:a pre-standardization group (n=37) and a post-standardization group (n=28). The thoracoscopic operative time was significantly shorter (p=0.0037) in the post-standardization group (n=28; 267 ± 31 min) than in the pre-standardization group (n=37;301 ± 53 min). Further, learning curve analysis using the moving average method showed stabilization of the thoracoscopic operative time after the standardization. No significant differences were found in the number of mediastinal lymph nodes dissected or intraoperative blood loss between the 2 groups. There were also no significant differences in the complication rate. Assistant-based surgery and standardization of the procedure resulted in a well-exposed and safe surgical field. TEPP decreased the operative time, even in patients requiring extensive lymphadenectomy.
authors.affiliation: Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.yasuwr@md.okayama-u.ac.jp.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shirakawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Noma
authors.forename: Naoaki
authors.initials: N
authors.lastname: Maeda
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Katsube
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Tanabe
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ohara
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Sakurama
authors.forename: Toshiyoshi
authors.initials: T
authors.lastname: Fujiwara
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery; D000368:Aged; D018278:Carcinoma, Neuroendocrine / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery*; D006804:Ergonomics; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000592:standards; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D056888:Patient Positioning / Q000379:methods / Q000592:standards*; D011183:Postoperative Complications / Q000517:prevention & control; D016684:Prone Position; D066231:Surgeons; D013906:Thoracoscopy / Q000379:methods / Q000592:standards*