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首页> 外文期刊>Surgical Endoscopy >Video: transcervical videoscopic esophageal dissection in minimally invasive esophagectomy.
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Video: transcervical videoscopic esophageal dissection in minimally invasive esophagectomy.

机译：视频：在微创食管切除术中经宫颈镜下食管解剖。

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BACKGROUND: Minimally invasive esophagectomy (MIE) may involve video-assisted thoracoscopic surgery (VATS) for mediastinal esophageal dissection. Usually, VATS requires single-lung ventilation and has associated cardiopulmonary morbidity [1-3]. Alternatively, transhiatal dissection can be performed, although its complications include vocal cord palsy [4], cardiac arrythmias [5], and increased bleeding [5, 6], the latter associated with mortality after esophagectomy [2]. Therefore, the feasibility of MIE using transcervical videoscopic esophageal dissection (TVED) in swine was investigated. A simultaneous laparoscopic and TVED approach may decrease operative time and blood loss while improving visualization and avoiding single-lung ventilation. METHODS: Two pigs (Sus domesticus) underwent two similar procedures. The methods were approved by the authors' Institutional Animal Care and Use Committee (no. A24209) under United States Department of Agriculture guidelines. Steps included a cervical incision to accommodate a modified hand-assist access device. The cervical esophagus was dissected. Trocars were placed through the modified access device, and pneumomediastinum was established. The tracheoesophageal plane was dissected into the thorax and beyond the mid esophagus, on which the pleura of the separate mediastinal compartment inserts itself. Vagal nerves were identified and divided distal to recurrent branches. Standard laparoscopic techniques were used for esophagogastric dissection. After specimen extraction, the animals were euthanized. RESULTS: A full circumferential dissection of the mediastinal esophagus was successfully accomplished in two animals using a single-incision TVED for MIE. CONCLUSIONS: A novel technique for mediastinal esophageal dissection using a TVED approach performed with instruments designed for single-port surgery is described. Fortunately, the human lacks the swine's separate mediastinal compartment, and this unique difference should facilitate the human version of this dissection. This approach may avoid the potential morbidity of VATS while providing better visualization and facilitating dissection of the upper mediastinal esophagus compared with either the transhiatal approach or the previously attempted rigid mediastinoscopic approaches [7-9].
机译：背景：微创食管切除术（MIE）可能需要进行纵隔食管解剖的电视胸腔镜手术（VATS）。通常，VATS需要单肺通气，并伴有相关的心肺疾病[1-3]。另外，可以进行经孔的解剖，尽管其并发症包括声带麻痹[4]，心脏的心律不齐[5]和出血增多[5，6]，后者与食管切除术后的死亡率有关[2]。因此，研究了在猪中使用经宫颈电镜食管解剖术（TVED）进行MIE的可行性。腹腔镜和TVED的同时使用方法可以减少手术时间和失血量，同时改善可视性并避免单肺通气。方法：对两只猪（Sus domesticus）进行两次相似的操作。该方法已获得美国农业部指导原则的作者机构动物护理和使用委员会（编号A24209）批准。步骤包括宫颈切口，以容纳改良的手助进入装置。解剖宫颈食道。通过改良的进入装置放置套管针，并建立了纵隔肺炎。将气管食管平面切开进入胸腔，并超出食道中部，在该处食管纵隔隔层的胸膜插入其自身。迷走神经被识别，并从远端分支到复发分支。标准的腹腔镜技术用于食管胃清扫术。标本提取后，对动物实施安乐死。结果：使用MIE单切口TVED成功地在两只动物中完成了纵隔食管的全周解剖。结论：描述了一种新的技术，用于TVED方法的纵隔食管解剖，该技术采用专为单口手术设计的器械进行。幸运的是，人类没有猪的纵隔隔室，这种独特的差异应该有助于这种解剖的人类版本。与经食管穿刺方法或先前尝试的硬性纵隔镜检查方法相比，这种方法可避免VATS的潜在发病率，同时提供更好的可视化并促进对上纵隔食管的解剖[7-9]。

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