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. 2023 Jul-Sep;19(3):450-452.
doi: 10.4103/jmas.jmas_356_22.

Uniportal video-assisted thoracoscopic Ivor Lewis oesophagectomy

Shiv Rajan  1 , Vijay Kumar  1 , Arun Chaturvedi  1 , Ajay Kumar Chaudhary  2 , Diego Gonzalez-Rivas  3
Affiliations

Uniportal video-assisted thoracoscopic Ivor Lewis oesophagectomy

Shiv Rajan et al. J Minim Access Surg. 2023 Jul-Sep.

Abstract

Standard minimally invasive Ivor Lewis oesophagectomy is performed through a multiport technique using carbon dioxide. However, access to video-assisted thoracoscopic surgery (VATS) is increasingly shifting to a single-port approach due to its proven safety and efficacy in lung surgeries. Therefore, the preamble of this submission is to describe, 'How I do differently' uniportal VATS MIO in three major steps: (a) VATS dissection through a single 4-cm incision in a semi-prone position without artificial capnothorax; (b) fluorescence dye to check conduit perfusion and (c) intrathoracic overlay anastomosis with a linear stapler.

Keywords: Carbon dioxide; indocyanine green; intrathoracic; oesophagus; single port; stapler.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Patient positioning and camera setup at the operating table. ICG: Indocyanine green, PAC: Posterior Axillary Crease / fold/line
Figure 2
Figure 2
(a) Azygous vein ligation and division, (b) Intrathoracic oesophageal division with a linear stapler, (c) Delivery of stomach conduit in the chest
Figure 3
Figure 3
(a) ICG perfusion in contrast mode, (b) ICG perfusion in colour-segmented mode, (c) Division of stomach and specimen delivery, (d) NG tube delivery from oesophageal opening into the thorax. ICG: Indocyanine green, NG: Nasogastric
Figure 4
Figure 4
(a) Anastomosis site marking, (b) Advancing one limb of the linear stapler into the stomach, (c) Advancing the second limb of the linear stapler into the oesophagus, (d) Checking anastomosis leak, (e) Completed anastomosis
Figure 5
Figure 5
(a) Patient positioning at the chest closure, (b) Post-operative X-ray shows no contrast leak across the anastomosis
See this image and copyright information in PMC

References

    1. Batirel HF. Techniques of uniportal video-assisted thoracic surgery-esophageal and mediastinal indications. J Thorac Dis. 2019;11(Suppl 16):S2108–14. - PMC - PubMed
    1. Rajan S, Akhtar N, Kumar V, Arya S, Tiwari T, Kannojiya DP. Uniportal video-assisted thoracoscopic surgery in semi-prone position utilising direct endobronchial intubation for oesophagus leiomyoma excision. J Minim Access Surg. 2023;19:172–4. - PMC - PubMed
    1. Lv W, Zeng G, Wu W, Wei W, Li X, Yang W. Application of single-port video-assisted thoracoscope in treating thoracic oesophageal squamous cell carcinoma using McKeown approach. J Minim Access Surg. 2018;14:105–10. - PMC - PubMed
    1. Froiio C, Uzun E, Hadzijusufovic E, Capovilla G, Berlth F, Lang H, et al. Semiprone thoracoscopic approach during totally minimally invasive Ivor-Lewis esophagectomy seems to be beneficial. Dis Esophagus. 2023;36:doac044. - PubMed
    1. Casas MA, Angeramo CA, Bras Harriott C, Dreifuss NH, Schlottmann F. Indocyanine green (ICG) fluorescence imaging for prevention of anastomotic leak in totally minimally invasive Ivor Lewis Esophagectomy: A systematic review and meta-analysis. Dis Esophagus. 2022;35:doab056. - PubMed