Transhiatal esophagectomy - Revision history

Chris.Rishel: Text replacement - "|Respiratory" to "|Pulmonary"

2022-02-22T05:46:57Z

Text replacement - "|Respiratory" to "|Pulmonary"

← Older revision		Revision as of 22:46, 21 February 2022
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	\|		\|
	\|-		\|-
	\|~~Respiratory~~		\|Pulmonary
	\|		\|
	\|-		\|-

Nkamdar: Changed intro paragraph

2021-09-02T17:43:32Z

Changed intro paragraph

← Older revision		Revision as of 10:43, 2 September 2021
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	}}		}}

	An esophagectomy remains a formidable surgery with high morbidity and mortality<sup>[1]</sup>. It is performed for esophageal cancer and non-malignant conditions including hiatal hernias, severe GERD refractory to medical management, esophageal strictures and diverticula, and dysmotility disorders such as achalasia<ref>{{Cite journal\|last=Ng\|first=Ju-Mei\|date=2008-06\|title=Perioperative Anesthetic Management for Esophagectomy\|url=https://doi.org/10.1016/j.anclin.2008.01.004\|journal=Anesthesiology Clinics\|volume=26\|issue=2\|pages=293–304\|doi=10.1016/j.anclin.2008.01.004\|issn=1932-2275}}</ref>. Anesthetic management may contribute to the improvement of perioperative outcomes; such factors include prevention of tracheal aspiration, lung protective ventilatory strategies, thoracic epidural analgesia, judicious fluid management to optimize tissue oxygen delivery, and attention to issues that may reduce anastomotic complications<ref>{{Cite journal\|last=Jaeger\|first=J. Michael\|last2=Collins\|first2=Stephen R.\|last3=Blank\|first3=Randal S.\|date=2012-12\|title=Anesthetic management for esophageal resection\|url=https://pubmed.ncbi.nlm.nih.gov/23089506\|journal=Anesthesiology Clinics\|volume=30\|issue=4\|pages=731–747\|doi=10.1016/j.anclin.2012.08.005\|issn=1932-2275\|pmid=23089506}}</ref>.		The transhiatal approach is used with a laparotomy below the xiphisternum to mobilize the stomach and create an esophageal conduit from the greater curvature of the stomach. This conduit is brought up to the neck for a gastroesophageal anastamosis at the level of a neck incision.<ref name=":1">{{Citation\|last=Nottingham\|first=James M.\|title=Transhiatal Esophagectomy\|date=2021\|url=http://www.ncbi.nlm.nih.gov/books/NBK559196/\|work=StatPearls\|place=Treasure Island (FL)\|publisher=StatPearls Publishing\|pmid=32644622\|access-date=2021-06-17\|last2=McKeown\|first2=David G.}}</ref> With advances in laparoscopic and robotic surgical techniques, the transhiatal esophagestomy has been increasing in popularity once again.

	Esophageal cancer incidence has been increasing and is now the eighth most common malignancy worldwide. Despite overall poor prognosis with this malignancy, surgery plays a significant role to increase long-term survival and possible cure. The transhiatal approach is used with a laparotomy below the xiphisternum to mobilize the stomach and create an esophageal conduit from the greater curvature of the stomach. This conduit is brought up to the neck for a gastroesophageal anastamosis at the level of a neck incision<ref name=":1">{{Citation\|last=Nottingham\|first=James M.\|title=Transhiatal Esophagectomy\|date=2021\|url=http://www.ncbi.nlm.nih.gov/books/NBK559196/\|work=StatPearls\|place=Treasure Island (FL)\|publisher=StatPearls Publishing\|pmid=32644622\|access-date=2021-06-17\|last2=McKeown\|first2=David G.}}</ref>~~. While an open approach was used traditionally, surgeons changed to favor the transthoracic approach originally described by Ivor Lewis.~~ With advances in laparoscopic and robotic surgical techniques, the transhiatal esophagestomy has been increasing in popularity once again. Thoracoscopic and robotic approaches have reduced the pulmonary complications and hastened the recovery period. Minimally invasive approaches allow for direct visualization within the thoracic cavity to reduce chances of injury during dissection.<ref name=":1" />

	== Preoperative management ==		== Preoperative management ==

Nkamdar at 22:59, 17 June 2021

2021-06-17T22:59:37Z

← Older revision		Revision as of 15:59, 17 June 2021
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	}}		}}

	An esophagectomy remains a formidable surgery with high morbidity and mortality<sup>[1]</sup>. It is performed for esophageal cancer and non-malignant conditions including hiatal hernias, severe GERD refractory to medical management, esophageal strictures and diverticula, and dysmotility disorders such as achalasia<~~sup~~>[2]</~~sup~~>. Anesthetic management may contribute to the improvement of perioperative outcomes; such factors include prevention of tracheal aspiration, lung protective ventilatory strategies, thoracic epidural analgesia, judicious fluid management to optimize tissue oxygen delivery, and attention to issues that may reduce anastomotic complications<~~sup~~>~~[3]~~</~~sup~~>.		An esophagectomy remains a formidable surgery with high morbidity and mortality<sup>[1]</sup>. It is performed for esophageal cancer and non-malignant conditions including hiatal hernias, severe GERD refractory to medical management, esophageal strictures and diverticula, and dysmotility disorders such as achalasia<ref>{{Cite journal\|last=Ng\|first=Ju-Mei\|date=2008-06\|title=Perioperative Anesthetic Management for Esophagectomy\|url=https://doi.org/10.1016/j.anclin.2008.01.004\|journal=Anesthesiology Clinics\|volume=26\|issue=2\|pages=293–304\|doi=10.1016/j.anclin.2008.01.004\|issn=1932-2275}}</ref>. Anesthetic management may contribute to the improvement of perioperative outcomes; such factors include prevention of tracheal aspiration, lung protective ventilatory strategies, thoracic epidural analgesia, judicious fluid management to optimize tissue oxygen delivery, and attention to issues that may reduce anastomotic complications<ref>{{Cite journal\|last=Jaeger\|first=J. Michael\|last2=Collins\|first2=Stephen R.\|last3=Blank\|first3=Randal S.\|date=2012-12\|title=Anesthetic management for esophageal resection\|url=https://pubmed.ncbi.nlm.nih.gov/23089506\|journal=Anesthesiology Clinics\|volume=30\|issue=4\|pages=731–747\|doi=10.1016/j.anclin.2012.08.005\|issn=1932-2275\|pmid=23089506}}</ref>.

	Esophageal cancer incidence has been increasing and is now the eighth most common malignancy worldwide. Despite overall poor prognosis with this malignancy, surgery plays a significant role to increase long-term survival and possible cure. The transhiatal approach is used with a laparotomy below the xiphisternum to mobilize the stomach and create an esophageal conduit from the greater curvature of the stomach. This conduit is brought up to the neck for a gastroesophageal anastamosis at the level of a neck incision<ref name=":1">{{Citation\|last=Nottingham\|first=James M.\|title=Transhiatal Esophagectomy\|date=2021\|url=http://www.ncbi.nlm.nih.gov/books/NBK559196/\|work=StatPearls\|place=Treasure Island (FL)\|publisher=StatPearls Publishing\|pmid=32644622\|access-date=2021-06-17\|last2=McKeown\|first2=David G.}}</ref>. While an open approach was used traditionally, surgeons changed to favor the transthoracic approach originally described by Ivor Lewis. With advances in laparoscopic and robotic surgical techniques, the transhiatal esophagestomy has been increasing in popularity once again. Thoracoscopic and robotic approaches have reduced the pulmonary complications and hastened the recovery period. Minimally invasive approaches allow for direct visualization within the thoracic cavity to reduce chances of injury during dissection.<ref name=":1" />		Esophageal cancer incidence has been increasing and is now the eighth most common malignancy worldwide. Despite overall poor prognosis with this malignancy, surgery plays a significant role to increase long-term survival and possible cure. The transhiatal approach is used with a laparotomy below the xiphisternum to mobilize the stomach and create an esophageal conduit from the greater curvature of the stomach. This conduit is brought up to the neck for a gastroesophageal anastamosis at the level of a neck incision<ref name=":1">{{Citation\|last=Nottingham\|first=James M.\|title=Transhiatal Esophagectomy\|date=2021\|url=http://www.ncbi.nlm.nih.gov/books/NBK559196/\|work=StatPearls\|place=Treasure Island (FL)\|publisher=StatPearls Publishing\|pmid=32644622\|access-date=2021-06-17\|last2=McKeown\|first2=David G.}}</ref>. While an open approach was used traditionally, surgeons changed to favor the transthoracic approach originally described by Ivor Lewis. With advances in laparoscopic and robotic surgical techniques, the transhiatal esophagestomy has been increasing in popularity once again. Thoracoscopic and robotic approaches have reduced the pulmonary complications and hastened the recovery period. Minimally invasive approaches allow for direct visualization within the thoracic cavity to reduce chances of injury during dissection.<ref name=":1" />

Nkamdar at 22:57, 17 June 2021

2021-06-17T22:57:21Z

← Older revision		Revision as of 15:57, 17 June 2021
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	===== Anastamosis: =====		===== Anastamosis: =====

			* Avoid excessive vasopressors to uphold integrity of anastamosis site

	=== 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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	=== 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. --> ===

			* Vocal cord palsy
			* Anastamotic leak
			* General pulmonary failure/complications

	== 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). --> ==

Nkamdar at 22:54, 17 June 2021

2021-06-17T22:54:40Z

← Older revision		Revision as of 15:54, 17 June 2021
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	===== Abdominal laparoscopy: =====		===== Abdominal laparoscopy: =====

	===== Gastric ~~anastamosis~~: =====		===== Gastric conduit creation: =====

	===== Esophageal transection: =====		===== Esophageal transection: =====

	===== Gastric pull-through: =====		===== Gastric pull-through: =====

			* Watch peak and plateau pressures for signs of pneumothorax
			* Compression of RA may cause sudden hypotension

	===== Anastamosis: =====		===== Anastamosis: =====

Nkamdar: Introductory description; general surgical approach table

2021-06-17T22:49:10Z

Introductory description; general surgical approach table

← Older revision		Revision as of 15:49, 17 June 2021
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	An esophagectomy remains a formidable surgery with high morbidity and mortality<sup>[1]</sup>. It is performed for esophageal cancer and non-malignant conditions including hiatal hernias, severe GERD refractory to medical management, esophageal strictures and diverticula, and dysmotility disorders such as achalasia<sup>[2]</sup>. Anesthetic management may contribute to the improvement of perioperative outcomes; such factors include prevention of tracheal aspiration, lung protective ventilatory strategies, thoracic epidural analgesia, judicious fluid management to optimize tissue oxygen delivery, and attention to issues that may reduce anastomotic complications<sup>[3]</sup>.		An esophagectomy remains a formidable surgery with high morbidity and mortality<sup>[1]</sup>. It is performed for esophageal cancer and non-malignant conditions including hiatal hernias, severe GERD refractory to medical management, esophageal strictures and diverticula, and dysmotility disorders such as achalasia<sup>[2]</sup>. Anesthetic management may contribute to the improvement of perioperative outcomes; such factors include prevention of tracheal aspiration, lung protective ventilatory strategies, thoracic epidural analgesia, judicious fluid management to optimize tissue oxygen delivery, and attention to issues that may reduce anastomotic complications<sup>[3]</sup>.

	Esophageal cancer incidence has been increasing and is now the eighth most common malignancy worldwide. Despite overall poor prognosis with this malignancy, surgery plays a significant role to increase long-term survival and possible cure. The transhiatal approach is used with a laparotomy below the xiphisternum to mobilize the stomach~~, which serves as~~ an esophageal conduit ~~and~~ the anastamosis ~~is made~~ at the level of a neck incision. While an open approach was used traditionally, surgeons changed to favor the transthoracic approach originally described by Ivor Lewis. ~~WIth~~ advances in laparoscopic and robotic surgical techniques, the transhiatal esophagestomy has been increasing in popularity.		Esophageal cancer incidence has been increasing and is now the eighth most common malignancy worldwide. Despite overall poor prognosis with this malignancy, surgery plays a significant role to increase long-term survival and possible cure. The transhiatal approach is used with a laparotomy below the xiphisternum to mobilize the stomach and create an esophageal conduit from the greater curvature of the stomach. This conduit is brought up to the neck for a gastroesophageal anastamosis at the level of a neck incision<ref name=":1">{{Citation\|last=Nottingham\|first=James M.\|title=Transhiatal Esophagectomy\|date=2021\|url=http://www.ncbi.nlm.nih.gov/books/NBK559196/\|work=StatPearls\|place=Treasure Island (FL)\|publisher=StatPearls Publishing\|pmid=32644622\|access-date=2021-06-17\|last2=McKeown\|first2=David G.}}</ref>. While an open approach was used traditionally, surgeons changed to favor the transthoracic approach originally described by Ivor Lewis. With advances in laparoscopic and robotic surgical techniques, the transhiatal esophagestomy has been increasing in popularity once again. Thoracoscopic and robotic approaches have reduced the pulmonary complications and hastened the recovery period. Minimally invasive approaches allow for direct visualization within the thoracic cavity to reduce chances of injury during dissection.<ref name=":1" />

	== Preoperative management ==		== Preoperative management ==

Elmar.Malek: introduction

2021-06-17T19:01:07Z

introduction

← Older revision		Revision as of 12:01, 17 June 2021
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	}}		}}

	Esophageal cancer incidence has been increasing and is now the eighth most common malignancy worldwide. Despite overall poor prognosis with this malignancy, surgery plays a significant role to increase long-term survival and possible cure. The transhiatal approach is used with a laparotomy below the xiphisternum to mobilize the stomach, which serves as an esophageal conduit and the anastamosis is made at the level of a neck incision. While an open approach was used traditionally, surgeons changed to favor the transthoracic approach originally described by Ivor Lewis. WIth advances in laparoscopic and robotic surgical techniques, the transhiatal esophagestomy has been increasing in popularity.		An esophagectomy remains a formidable surgery with high morbidity and mortality<sup>[1]</sup>. It is performed for esophageal cancer and non-malignant conditions including hiatal hernias, severe GERD refractory to medical management, esophageal strictures and diverticula, and dysmotility disorders such as achalasia<sup>[2]</sup>. Anesthetic management may contribute to the improvement of perioperative outcomes; such factors include prevention of tracheal aspiration, lung protective ventilatory strategies, thoracic epidural analgesia, judicious fluid management to optimize tissue oxygen delivery, and attention to issues that may reduce anastomotic complications<sup>[3]</sup>.

			Esophageal cancer incidence has been increasing and is now the eighth most common malignancy worldwide. Despite overall poor prognosis with this malignancy, surgery plays a significant role to increase long-term survival and possible cure. The transhiatal approach is used with a laparotomy below the xiphisternum to mobilize the stomach, which serves as an esophageal conduit and the anastamosis is made at the level of a neck incision. While an open approach was used traditionally, surgeons changed to favor the transthoracic approach originally described by Ivor Lewis. WIth advances in laparoscopic and robotic surgical techniques, the transhiatal esophagestomy has been increasing in popularity.

	== Preoperative management ==		== Preoperative management ==

Nkamdar: opening paragraph.

2021-06-17T18:30:41Z

opening paragraph.

← Older revision		Revision as of 11:30, 17 June 2021
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	}}		}}

	~~Provide~~ a ~~brief summary~~ of ~~this~~ surgical ~~procedure and its indications here~~.		Esophageal cancer incidence has been increasing and is now the eighth most common malignancy worldwide. Despite overall poor prognosis with this malignancy, surgery plays a significant role to increase long-term survival and possible cure. The transhiatal approach is used with a laparotomy below the xiphisternum to mobilize the stomach, which serves as an esophageal conduit and the anastamosis is made at the level of a neck incision. While an open approach was used traditionally, surgeons changed to favor the transthoracic approach originally described by Ivor Lewis. WIth advances in laparoscopic and robotic surgical techniques, the transhiatal esophagestomy has been increasing in popularity.

	== Preoperative management ==		== Preoperative management ==

Nkamdar: updated procedure variants and maintenance of anesthesia.

2021-06-17T18:17:37Z

updated procedure variants and maintenance of anesthesia.

← Older revision		Revision as of 11:17, 17 June 2021
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	* Supine with both arms tucked		* Supine with both arms tucked

	=== 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 ===

			===== Abdominal laparoscopy: =====

			===== Gastric anastamosis: =====

			===== Esophageal transection: =====

			===== Gastric pull-through: =====

			===== Anastamosis: =====

	=== 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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	{\| class="wikitable"		{\| class="wikitable"
	\|+		\|+
			* Very few series have been published comparing robotic and laparoscopic approach.
	!		!
	!Laparoscopic		!Laparoscopic
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	\|-		\|-
	\|Position		\|Position
	\|		\|Supine
	\|		\|Supine; arms tucked
	\|-		\|-
	\|Surgical time		\|Surgical time
	\|		\|279min<ref name=":0">{{Cite journal\|last=Seto\|first=Yasuyuki\|last2=Mori\|first2=Kazuhiko\|last3=Aikou\|first3=Susumu\|date=2017-09\|title=Robotic surgery for esophageal cancer: Merits and demerits\|url=https://pubmed.ncbi.nlm.nih.gov/29863149\|journal=Annals of Gastroenterological Surgery\|volume=1\|issue=3\|pages=193–198\|doi=10.1002/ags3.12028\|issn=2475-0328\|pmc=5881348\|pmid=29863149}}</ref>
	\|		\|267-311min
	\|-		\|-
	\|EBL		\|EBL
	\|		\|88mL<ref name=":0" />
	\|		\|54-100mL
	\|-		\|-
	\|Postoperative disposition		\|Postoperative disposition
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	\|Pain management		\|Pain management
	\|		\|
	\|		\|Epidural
	\|-		\|-
	\|Potential complications		\|Potential complications
	\|		\|
	\|		\|Pulmonary

			Anastamotic leak (9-33%)

			Vocal cord palsy (5-30%)
			\|-
			\|Length of Stay
			\|9.2 days<ref name=":0" />
			\|9-10 days
	\|}		\|}

Nkamdar at 16:16, 17 June 2021

2021-06-17T16:16:11Z

← Older revision		Revision as of 09:16, 17 June 2021
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	\| airway = 8-O ETT		\| airway = 8-O ETT
	\| lines_access = Large bore PIV		\| lines_access = Large bore PIV
			Arterial Line
			NG-tube
	\| monitors = Standard		\| monitors = Standard
	Arterial Line		Arterial Line
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	=== 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. --> ===		=== 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. -->~~ ===		=== Operating room setup ===

			* 8-O ETT for periemergence bronchoscopy
			* Arterial line
			* Large bore peripheral IV
			* NG tube to decompress stomach

			=== Patient preparation and premedication ===

			* EKG leads on back of shoulders to facilitate neck prep

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

	~~=== 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. -~~-~~> ===~~		* Epidural for post-operative pain control

	== Intraoperative management ==		== 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. -->~~ ===		=== Monitoring and access ===

			* Standard ASA Monitors
			* Arterial line

	=== 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. --> ===

	=== 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. --> ===

			* Supine with both arms tucked

	=== 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. --> ===