Assistant-based standardization of prone position thoracoscopic esophagectomy

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Thoracoscopic esophagectomy in the prone position (TEPP) offers potential benefits for solo-surgery.
• Standardization is crucial for optimizing TEPP, especially for extensive lymphadenectomy.
• Previous TEPP approaches lacked standardization, potentially impacting operative efficiency.

Purpose of the Study:

• To evaluate the impact of an assistant-based standardized procedure on TEPP outcomes.
• To assess the feasibility and efficiency of standardized TEPP in patients requiring extensive lymphadenectomy.
• To analyze the learning curve and operative time stabilization after procedure standardization.

Main Methods:

• A retrospective study comparing pre-standardization (n=37) and post-standardization (n=28) groups undergoing TEPP.
• Development and implementation of an assistant-based standardized TEPP procedure.
• Analysis of thoracoscopic operative time, lymph node dissection, blood loss, and complication rates.

Main Results:

• The post-standardization group showed a significantly shorter mean thoracoscopic operative time (267 ± 31 min) compared to the pre-standardization group (301 ± 53 min; p=0.0037).
• Learning curve analysis indicated stabilization of operative time after standardization.
• No significant differences were observed in mediastinal lymph node counts, intraoperative blood loss, or complication rates between the groups.

Conclusions:

• Assistant-based standardization of TEPP leads to a well-exposed and safe surgical field.
• Standardized TEPP effectively reduces operative time, even in complex cases requiring extensive lymphadenectomy.
• This standardized approach enhances the efficiency and reproducibility of TEPP for esophageal cancer surgery.