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Three-dimensional visualization system is one of the factors that improve short-term outcomes after minimally
Takuya Kudo1, Taro Oshikiri2, Gosuke Takiguchi1
1Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Purpose:
Minimally invasive esophagectomy (MIE) has been increasingly used, but many reports have stated that recurrent laryngeal nerve (RLN) palsy after MIE is a major complication associated with postoperative pneumonia. Prevention of RLN palsy clearly has been a challenging task. The study aim was to determine if a three-dimensional (3-D) stereoscopic vision system can reduce the RLN palsy rate after MIE.
Methods:
This was a retrospective study of MIE (McKeown esophagectomy) using a 3-D or 2-D stereoscopic vision system to treat 358 patients in the prone position between April 2010 and March 2019. The patients who underwent 3-D MIE (3-D group) or 2-D MIE (2-D group) were matched by using propensity score matching. After matching, the perioperative outcomes were compared between the groups.
Results:
After propensity score matching, 154 patients were analyzed (77 patients, 3-D group; 77 patients, 2-D group). There were no significant differences in the patients' baseline characteristics in the matched cohort. There were no significant differences in the rates of pneumonia (Clavien-Dindo (C-D) grade ≥ II, 3-D vs. 2-D, 11 (14%) vs. 12 (16%)), anastomotic leakage (C-D grade ≥ II, 10 (13%) vs. 18 (23%)) and mortality. The rates of left RLN palsy (C-D grade ≥ IIIa, 1 (1.3%) vs. 7 (9.1%), P = 0.029), right RLN palsy (C-D grade ≥ I, 2 (3%) vs. 8 (10%), P = 0.049), comprehensive complication index (CCI®) (8.5 vs. 14.3, P = 0.011), and postoperative hospital stay period (median: 25 vs. 30 days, P = 0.034) were significantly lower in the 3-D group than in the 2-D group, respectively.
Conclusions:
In MIE, the 3-D viewing system was one of the factors that reduced postoperative morbidities such as the rates of each RLN palsy and CCI®, leading to shorter postoperative hospital stay.
Insights
Minimally invasive esophagectomy using a 3-D vision system significantly reduced recurrent laryngeal nerve palsy rates and complications. This advanced visualization led to shorter hospital stays for patients undergoing this complex surgery.
Area of Science:
- Thoracic Surgery
- Surgical Technology
- Minimally Invasive Procedures
Background:
- Minimally invasive esophagectomy (MIE) is increasingly adopted.
- Recurrent laryngeal nerve (RLN) palsy is a significant complication of MIE, often leading to postoperative pneumonia.
- Preventing RLN palsy during MIE remains a challenge.
Purpose of the Study:
- To evaluate the efficacy of a three-dimensional (3-D) stereoscopic vision system in reducing RLN palsy rates after MIE.
- To compare perioperative outcomes between 3-D and 2-D vision systems in MIE.
Main Methods:
- Retrospective analysis of 358 patients undergoing MIE (McKeown esophagectomy) in the prone position.
- Patients were divided into 3-D MIE and 2-D MIE groups.
- Propensity score matching was used to create comparable cohorts (77 patients per group) for outcome analysis.
Main Results:
- The 3-D MIE group showed significantly lower rates of left RLN palsy (1.3% vs. 9.1%) and right RLN palsy (3% vs. 10%) compared to the 2-D MIE group.
- The 3-D group also had a lower Comprehensive Complication Index (CCI®) (8.5 vs. 14.3) and a shorter postoperative hospital stay (25 vs. 30 days).
- No significant differences were observed in pneumonia or anastomotic leakage rates between the groups.
Conclusions:
- A 3-D stereoscopic vision system is a key factor in reducing postoperative morbidities, specifically RLN palsy rates, following MIE.
- The use of 3-D visualization in MIE contributes to improved patient outcomes, including a reduced CCI® and shorter hospital stays.
- 3-D vision systems represent an advancement in surgical technology for esophagectomy, enhancing safety and efficiency.
