Ivor Lewis esophagectomy - Revision history

Oliviamsutton at 13:55, 1 July 2022

2022-07-01T13:55:16Z

← Older revision		Revision as of 06:55, 1 July 2022
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	}}		}}

	~~Provide~~ a ~~brief summary~~ of ~~this surgical procedure~~ and ~~its indications here~~.		The Ivor-Lewis transthoracic esophagectomy can be used to resect cancers in the lower third of the esophagus. It is not the optimal approach for cancers located in the middle third because of the limited proximal margin that can be achieved. This procedure combines a laparotomy with a right thoracotomy and an intrathoracic esophagogastric anastomosis. This approach permits direct visualization of the thoracic esophagus and allows the surgeon to perform a full thoracic lymphadenectomy.

	== Preoperative management ==		== Preoperative management ==
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	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

	* Thoracic epidural		* Thoracic epidural (T7-8 commonly)

	== Intraoperative management ==		== Intraoperative management ==

Nkamdar at 20:27, 2 September 2021

2021-09-02T20:27:51Z

@@ Line 12: / Line 12: @@
 == Preoperative management ==
 === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
@@ Line 51: / Line 18: @@
 * Fluid warmer
 * Double-lumen tube (left) / bronchial blocker with SLT
 === Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
@@ Line 69: / Line 34: @@
 * May consider RSI if high-aspiration risk due to esophageal tumor obstructing food passage
 * Left sided double lumen tube or single lumen ETT with bronchial blocker for one lung ventilation
 === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===

Nkamdar at 16:24, 2 September 2021

2021-09-02T16:24:32Z

← Older revision		Revision as of 09:24, 2 September 2021
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	* May consider RSI if high-aspiration risk due to esophageal tumor obstructing food passage		* May consider RSI if high-aspiration risk due to esophageal tumor obstructing food passage
	* Left sided double lumen tube or single lumen ETT with bronchial blocker		* Left sided double lumen tube or single lumen ETT with bronchial blocker for one lung ventilation

	=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===

	* Start in supine position if EGD is used		* Start in supine position if EGD is used at the beginning of the case
	* Patient will be later positioned to left lateral decubitus		* Patient will be later positioned to left lateral decubitus for the thoracic portion of the resection

	=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===

Nkamdar at 16:23, 2 September 2021

2021-09-02T16:23:28Z

← Older revision		Revision as of 09:23, 2 September 2021
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	{{Infobox surgical procedure		{{Infobox surgical procedure
	\| anesthesia_type = General		\| anesthesia_type = General
	\| airway = DLT		\| airway = DLT / bronchial blocker
	\| lines_access = Large PIV, arterial line, NG tube		\| lines_access = Large PIV, arterial line, NG tube
	\| monitors = Standard, arterial line		\| monitors = Standard, arterial line

Nkamdar at 16:14, 2 September 2021

2021-09-02T16:14:38Z

← Older revision		Revision as of 09:14, 2 September 2021
Line 55:		Line 55:

	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

			* Thoracic epidural

	== Intraoperative management ==		== Intraoperative management ==
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	* Lower portion of the stomach is mobilized		* Lower portion of the stomach is mobilized
	* Gastric conduit formed		* Gastric conduit formed
	* A cervical ~~anastamosis~~ is performed and ~~esophogus~~ and stomach returned to mediastinum		* A cervical anastomosis is performed and esophagus and stomach returned to mediastinum


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	=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===		=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===

			# Anastomotic leak
			# Vocal cord paresis
			# Recurrent laryngeal nerve injury
			# Morbidity requiring re-operation
			# Mortality

	== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==		== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
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	\|Position		\|Position
	\|		\|
	\|Supine ~~then~~ left		\|Supine followed by left

	lateral decubitus		lateral decubitus

Nkamdar: surgical details

2021-09-02T04:21:29Z

surgical details

← Older revision		Revision as of 21:21, 1 September 2021
Line 50:		Line 50:
	* Arterial line +/- flowtrack (ideally on left arm)		* Arterial line +/- flowtrack (ideally on left arm)
	* Fluid warmer		* Fluid warmer
	* Double-lumen tube (left)		* Double-lumen tube (left) / bronchial blocker with SLT

	=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
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	* May consider RSI if high-aspiration risk due to esophageal tumor obstructing food passage		* May consider RSI if high-aspiration risk due to esophageal tumor obstructing food passage
	* Left sided double lumen tube		* Left sided double lumen tube or single lumen ETT with bronchial blocker

	=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
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	=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===

			==== Abdominal Dissection ====

			* Pt is placed supine and peritoneal cavity is examined for metastatic disease
			* Lower portion of the stomach is mobilized
			* Gastric conduit formed
			* A cervical anastamosis is performed and esophogus and stomach returned to mediastinum


	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
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	\|Position		\|Position
	\|		\|
	\|		\|Supine then left

			lateral decubitus
	\|		\|
	\|-		\|-
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	\|-		\|-
	\|Postoperative disposition		\|Postoperative disposition
	\|		\|ICU
	\|		\|ICU or ERAS
	\|		\|ICU or ERAS
	\|-		\|-
	\|Pain management		\|Pain management
	\|		\|Thoracic Epidural
	\|		\|Thoracic Epidural
	\|		\|Thoracic Epidural
	\|-		\|-
	\|Potential complications		\|Potential complications
	\|		\|
	\|		\|Anastamotic leak (4.3%)

			Vocal cord paresis (0.9%)

			Mortality (1.68%)<ref>{{Cite journal\|last=Luketich\|first=James D.\|last2=Pennathur\|first2=Arjun\|last3=Awais\|first3=Omar\|last4=Levy\|first4=Ryan M.\|last5=Keeley\|first5=Samuel\|last6=Shende\|first6=Manisha\|last7=Christie\|first7=Neil A.\|last8=Weksler\|first8=Benny\|last9=Landreneau\|first9=Rodney J.\|last10=Abbas\|first10=Ghulam\|last11=Schuchert\|first11=Matthew J.\|date=2012-07\|title=Outcomes after minimally invasive esophagectomy: review of over 1000 patients\|url=https://pubmed.ncbi.nlm.nih.gov/22668811\|journal=Annals of Surgery\|volume=256\|issue=1\|pages=95–103\|doi=10.1097/SLA.0b013e3182590603\|issn=1528-1140\|pmc=4103614\|pmid=22668811}}</ref>
	\|		\|
	\|}		\|}

Nkamdar at 18:46, 1 September 2021

2021-09-01T18:46:40Z

← Older revision		Revision as of 11:46, 1 September 2021
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	=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===		=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===

	* Arterial line +/- flowtrack		* Arterial line +/- flowtrack (ideally on left arm)
	* Fluid warmer		* Fluid warmer
	* Double-lumen tube		* Double-lumen tube (left)

	=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
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	=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===

			* May consider RSI if high-aspiration risk due to esophageal tumor obstructing food passage
			* Left sided double lumen tube

	=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===

			* Start in supine position if EGD is used
			* Patient will be later positioned to left lateral decubitus

	=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
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	=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===		=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===

			* Post-op ICU

	=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===		=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===

Nkamdar at 01:41, 1 September 2021

2021-09-01T01:41:21Z

← Older revision		Revision as of 18:41, 31 August 2021
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	\|+		\|+
	!		!
	!~~Variant 1~~		!Open
	!~~Variant 2~~		!Laparoscopic
			!Robotic
	\|-		\|-
	\|Unique considerations		\|Unique considerations
			\|
	\|		\|
	\|		\|
	\|-		\|-
	\|Position		\|Position
			\|
	\|		\|
	\|		\|
	\|-		\|-
	\|Surgical time		\|Surgical time
			\|
	\|		\|
	\|		\|
	\|-		\|-
	\|EBL		\|EBL
			\|
	\|		\|
	\|		\|
	\|-		\|-
	\|Postoperative disposition		\|Postoperative disposition
			\|
	\|		\|
	\|		\|
	\|-		\|-
	\|Pain management		\|Pain management
			\|
	\|		\|
	\|		\|
	\|-		\|-
	\|Potential complications		\|Potential complications
			\|
	\|		\|
	\|		\|

Nkamdar: Started page and added a few general items

2021-09-01T01:40:30Z

Started page and added a few general items

← Older revision	Revision as of 18:40, 31 August 2021
Line 1:	Line 1:
		{{Infobox surgical procedure
		\| anesthesia_type = General
		\| airway = DLT
		\| lines_access = Large PIV, arterial line, NG tube
		\| monitors = Standard, arterial line
		\| considerations_preoperative =
		\| considerations_intraoperative =
		\| considerations_postoperative =
		}}

		Provide a brief summary of this surgical procedure and its indications here.

		== Preoperative management ==

		=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
		{\| class="wikitable"
		\|+
		!System
		!Considerations
		\|-
		\|Neurologic
		\|
		\|-
		\|Cardiovascular
		\|
		\|-
		\|Respiratory
		\|
		\|-
		\|Gastrointestinal
		\|
		\|-
		\|Hematologic
		\|
		\|-
		\|Renal
		\|
		\|-
		\|Endocrine
		\|
		\|-
		\|Other
		\|
		\|}

		=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===

		=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===

		* Arterial line +/- flowtrack
		* Fluid warmer
		* Double-lumen tube

		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===

		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

		== Intraoperative management ==

		=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===

		* Invasive hemodynamic monitoring
		* Large bore IV access

		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===

		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===

		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===

		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

		== Postoperative management ==

		=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===

		=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===

		* Epidural

		=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===

		== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==

		{\| class="wikitable wikitable-horizontal-scroll"
		\|+
		!
		!Variant 1
		!Variant 2
		\|-
		\|Unique considerations
		\|
		\|
		\|-
		\|Position
		\|
		\|
		\|-
		\|Surgical time
		\|
		\|
		\|-
		\|EBL
		\|
		\|
		\|-
		\|Postoperative disposition
		\|
		\|
		\|-
		\|Pain management
		\|
		\|
		\|-
		\|Potential complications
		\|
		\|
		\|}

		== References ==

		[[Category:Surgical procedures]]

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