Thoracoscopic Esophagectomy in the Prone Position

Hidehito Shibasaki, MD PhD, Takahiro Kinoshita, MD PhD, Akira Ogata, MD PhD, Masaru Miyazaki, Prof. Matsudo City Hospital, Department of Surgery

Thoracoscopic esophagectomy performed with the patient in the left lateral position has been occasionally reported since the 1990s, but it has not been established as a standard procedure. This may be because the success of this procedure largely depends on the technical competence of an assistant to secure an adequate field of view during the procedure. Thoracoscopic esophagectomy with the patient in the prone position has recently been introduced and has been consistently shown to be useful. Compared with left lateral thoracoscopic esophagectomy, prone thoracoscopic esophagectomy requires less assistance in exposing the operative field, and it is relatively easy to obtain a satisfactory field of view. We performed prone thoracoscopic esophagectomy on 20 patients and were successful in achieving a wide field of view. The postoperative course was remarkably favorable in all patients, and the procedure is considered promising for standard thoracoscopic esophagectomy. There are few detailed reports of this procedure; herein, we describe the procedure of prone thoracoscopic esophagectomy employed at our hospital.

Outcomes of 20 patients who underwent thoracoscopic esophagectomy in the prone position
Age (years)	68.6 (49~81)
Male/female	15/5
Operation time (min)	554.2 ± 27.8 (450~680)
Blood loss (mL)	194 ± 114 (84~350)
Time of extubation	(days) 0.70 (0~1)
Start of oral intake (days)	3.3 (1~7)
Length of postoperative hospital stay (days)	17.8 (10~74)