Four-Point Support Frame Positioning for Obese Patients Undergoing Minimally Invasive Esophagectomy. A Preliminary...

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Prone minimally invasive esophagectomy presents technical challenges in obese patients due to increased abdominal pressure.
• Elevated diaphragms in obese patients can impede first-port placement and lower mediastinal access.
• Robot-assisted surgery requires adequate workspace and inter-arm distance, often compromised by these challenges.

Purpose of the Study:

• To describe a modified positioning technique for obese patients undergoing prone minimally invasive esophagectomy.
• To address challenges in port placement and surgical exposure in the lower mediastinum.
• To evaluate the feasibility of a 4-point support frame in improving operability.

Main Methods:

• A 4-point support frame was utilized to position obese patients.
• The frame supported the thorax and pelvis, allowing the abdomen to hang freely.
• This technique aimed to decrease abdominal compression and prevent diaphragmatic elevation.

Main Results:

• The modified positioning facilitated standard port placement.
• Stable exposure of the lower mediastinum was achieved.
• The technique proved practical in preliminary institutional experience.

Conclusions:

• A 4-point support frame is a practical positioning modification for obese patients during prone minimally invasive esophagectomy.
• This technique may overcome challenges related to abdominal compression and diaphragmatic elevation.
• It offers a reproducible option for improving surgical access in selected obese patients.