First Experience with Three-Dimensional Thoracolaparoscopy in Esophageal Cancer Surgery

Endoscopic techniques are rapidly gaining interest in esophageal cancer surgery due to lower pulmonary complication rates and faster postoperative recovery. Conventional two-dimensional endoscopic surgery has two main limitations: lack of depth perception and limited dexterity due to the use of rigid instruments. Theoretically, three-dimensional (3D) endoscopy can overcome these limitations, but to date, its use has not been reported in the context of esophageal cancer surgery. We studied our first series of 3D thoracolaparoscopic esophagectomies to document the safety and feasibility of implementing this technique.

Patients who underwent a thoracolaparoscopic esophagectomy using a glasses-based 3D system with a 100° angulating camera tip were included. Continuity of the digestive tract was restored with gastric tube reconstruction and a cervical anastomosis.

All 13 resections were completed thoracolaparoscopically. Median duration of surgery was 360 minutes (range: 245-590 minutes), and median blood loss was 170 mL (range: 50-230 mL). A median of 20 lymph nodes was resected, and all resections were microscopically radical. Median hospital stay was 9 days. Two patients developed pneumonia (15%), and three patients experienced an anastomotic leakage (23%). All postoperative complications were managed on the ward.

In this series, the newest generation glasses-based 3D systems proved safe and useful for the thoracolaparoscopic resection of esophageal cancer. Besides better visualization, dexterity seemed to be improved using the 100° flexible 3D camera. Implementation was without significant problems, and the first results are promising.