title: Thoracoscopic Esophagectomy in the Prone Position Versus the Lateral Position (Hand-assisted Thoracoscopic Surgery): A Retrospective Cohort Study of 127 Consecutive Esophageal Cancer Patients.
abstract: OBJECTIVE
  To assess the validity of esophagectomy with the patient in the prone position (PP), the short-term surgical results of PP and hand-assisted thoracoscopic surgery (HATS) were compared.
  
  
  METHODS
  This study enrolled 127 patients who underwent esophagectomy with HATS (n=91) or PP (n=36) between October 1999 and September 2014. The patients' background characteristics, operative findings, and postoperative complications were examined.
  
  
  RESULTS
  The patients' background characteristics were not significantly different. During surgery, total and thoracic blood loss were significantly lower in PP than in HATS (P<0.0001, <0.0001). Other operative findings were not significantly different between the 2 groups. Postoperatively, recurrent nerve palsy was significantly less frequent in PP than in HATS (P=0.049). In the comparison between the recurrent nerve palsy-positive and palsy-negative groups, sex (male) and preoperative respiratory comorbidity (negative) were significantly correlated with recurrent nerve palsy.
  
  
  CONCLUSIONS
  In thoracoscopic esophagectomy, the PP was associated with lower surgical stress than HATS, with equal operative performance oncologically. The PP could prevent recurrent nerve palsy because of the magnified view effect.
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Fukuda
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shichinohe
authors.forename: Yuma
authors.initials: Y
authors.lastname: Ebihara
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Nakanishi
authors.forename: Toshimichi
authors.initials: T
authors.lastname: Asano
authors.forename: Takehiro
authors.initials: T
authors.lastname: Noji
authors.forename: Yo
authors.initials: Y
authors.lastname: Kurashima
authors.forename: Toru
authors.initials: T
authors.lastname: Nakamura
authors.forename: Soichi
authors.initials: S
authors.lastname: Murakami
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuchikawa
authors.forename: Keisuke
authors.initials: K
authors.lastname: Okamura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016684:Prone Position; D011788:Quality of Life; D012189:Retrospective Studies; D013312:Stress, Physiological / Q000502:physiology; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000209:etiology; D055815:Young Adult