Short-term Outcomes Of Laparoscopy Without Abdominal Incision Combined With Minimal Thoracic Incision Esophagectomy In 30 Cases

Objective: To investigate the clinical application of laparoscopy without abdominal incision combined with minimal thoracic incision esophagectomy in esophageal carcinoma surgery.By observing the time of thoracic surgery and abdominal surgery,loss of blood during surgery,the gastric tube drainage of the first three days and the time of gastric tube removal,the chest tube drainage of the first three days and the time of chest tube drainage,the time of ambulation after surgery,the time of fart after surgery,the time of eating after surgery,postoperative hospital stay,lymph node harvest,postoperative complication and pain score during first 24 hour,to evaluate the safety,feasibility and short-term outcomes of laparoscopy without abdominal incision combined with minimal thoracic incision esophagectomy.Methods: We conducted 30 cases of laparoscopy without abdominal incision combined with minimal thoracic incision esophagectomy from February 2012 to Octomber 2015.All patients were confirmed esophageal carcinoma by gastroscopye and biopsy.The cancer all located in the middle and lower third thoracic.The right thoracic and abdomen incision were chosen.The right thoracic incision was made 10-12 cm in the right fifth intercostal space,and the abdomen surgery was under totally laparoscopy.The procedure was as follows: 1.To remove the stomach and D2 lymph nodes dissection under laparoscopy,with the diaphragmatic esophageal hiatus the proximal and the pylorus the distal.We ligated the left gastric omentum artery,the short gastric artery,the left gastric artery,the distal part of the second branches of the right gastric artery,and we preserve the left gastric omentum artery and the remnant right gastric artery.2.Part of the gastric tube was made in the abdomen with Endoscopic Linear Cutter.3.Trocar was chosen in the right posterior axillary line,and the right thoracic incision was made 10-12 cm in the right fifth intercostal space.We ligated and cut the azygos vein.4.After finishing the dissection of esophagus to the thoracic inlet and removing the thoracic lymph nodes,the stomach was pulled into the thoracic cavity and anastomosed to the esophagus.The whole gastric tube was made using Ethicon 60 mm articulating Endoscopic Linear Cutter in the thoracic cavity.Results: All surgery were performed successfully except one converted to laparotomy to stanch bleeding.The median operation time was 160 min,with abdominal 110 min and thoracic 50 min.Mean blood loss was 25 ml.The gastric tube drainage of the first three days were 50 ml,200ml,and 150 ml.The chest tube drainage of the first three days were 200 ml,150ml,and 40 ml.The time of ambulation was 4 days after surgery.We remove the gastric tube on day 3-6 after farting.The chest tube was removed on day 4-6.On day 7,liquid diet was given after drinking of water.All the patients were discharged from hospital on day 9-12.No case of abdominal complication,anastomotic leakage,pulmonary complication or gastric retention was observed,except 6 patients with respiratory complication,which were cured with antibiotics and bronchoscopy.The mean lymph nodes harvest was 24,with abdomen 14 and chest 10.D2 lymph node dissection was performed in the abdomen and 2,4,7,8,9,10 lymph node were harvest in the thoracic cavity.Postoperative pain score: 0 point in 3 cases,1 point in 10 cases,2 points in 12 cases,3 points in 5 cases,and 4 points in 0 case.All cases were cured.Conclusion: Laparoscopy without abdominal incision combined with minimal thoracic incision esophagectomy has the advantage of less blood loss,less postoperative pain,less chest tube drainage and gastric tube drainage,quick recovery.Lymph node harvest was similar with traditional lapatomy,to achieve radiation of cancer.Laparoscopy without abdominal incision combined with minimal thoracic incision esophagectomy can be safely performed to achieve favorable early outcomes.