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Department of Thoracic Surgery completes novel thoracoscopic and laparoscopic MIE of esophageal cancer in complete prone position

Updated: May 13, 2022
From: Department of Thoracic Surgery
Edited by: Liu Huiting
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On May 11, the team led by Professor Fu Junke and Professor Zhang Guangjian from Department of Thoracic Surgery of the First Affiliated Hospital of Xi’an Jiaotong University (XJTU) completed thoracoscopic and laparoscopic radical resection of esophageal cancer in the complete prone position. Before surgery, the team of Professor Fu Junke and Professor Zhang Guangjian discussed the patient’s conditions with the team led by Director Wang Qiang and Professor Wen Jian from Department of Anesthesiology and Perioperative Medicine, and decided to adopt "three-portminimally invasive radical resection for esophageal cancer". After full preparation by the teams, the operation was successfully completed.

At present, thoracoscopic and laparoscopic minimally invasive esophagectomy (MIE) has been routinely carried out in large-scale medical centers. MIE is generally performed via four thoracic ports and four/five abdominal ports, and the tubular stomach is created through a 5-8cm incision in the upper abdomen. Different from routine MIE, this patient was kept  in a complete prone position throughout the thoracic surgery, actually "lying down" on the operation bed. The artificial pneumothorax and the gravity of the lung made the surgeons’ surgical field clearer and the patient's mediastinum could be exposed at an optimalangle, which contributed to accomplishing high-quality esophagectomy. This idea was firstly proposed by Japanese scholars mastering advanced therapeutic technologies for esophageal cancer. It was confirmed that such surgical pattern can improve clinical prognosis and quality of life of the patients. For this patient, Professor Fu Junke's team, for the first time, applied this demanding procedure in northwest China, representing that our hospital creates another breakthrough in MIE of esophageal cancer. Meantime, single-port procedure was adopted during intraoperative abdominal freeing via a 2-cm and a 1-cm incisions in the abdomen, which replaced conventional multi-port route and further mitigated surgical trauma of thepatient. After explicit preoperative planning and joint cooperation of Sun Ye, Li Yang, and chief nurse Cui Junjie from thoracic surgery group of Department of Anesthesiology and Perioperative Medicine, the 210-min surgery was successfully completed.

Under the leadership of Professor Fu Junke, Department of Thoracic Surgery of our hospital has systematically carried out thoracoscopic and laparoscopic MIE of esophageal cancer since 2012, realizing minimally invasive radical resection of esophageal cancer. Through persistent practice and learning, several key technologies in esophageal cancer surgery have been modified, and favorable surgical efficacy has been achieved. In the present case, esophageal freeing in complete full prone combined with laparoscopic single-port technology is adopted and the application of two minimally invasive concepts signifies the first attempt in northwest China and even across China. It is the thoracic surgery team’s another exploration regarding minimally invasive management of esophageal cancer, which will bring benefits to more patients with esophageal cancer.

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