Dr Pradeep Jain Fortis Hospital - Thoraco Laparoscopic Esophagectomy. Laparoscopic GI and GI Oncology Surgery, Dr. Pradeep Jain Fortis Hospital Review. He gained so much appreciation for his work and has so many happy patients.

1. Thoraco laparoscopic Esophagectomy
Dr Pradeep Jain M.Ch
Director
GI Surgery
Fortis Hospital Shalimar Bagh

2. Minimally Invasive Esophagectomy
 Enthusiasm -- Technical complexity &
Frequency

3. Lap > open
0
5
10
15
20
25
Cholecystectomy Gatric Bypass Esophagectomy

4. MIE (concerns)
 Safety
Surgery time
Blood loss
Morbidity and Mortality
 Recovery
ICU and Hospital Stay
Pain
 Oncological out come
LN yield and Resection margins
Survival
 Cost

5. Meta analysis
Biere SS, Cuesta MA, van der Peet D, Minimally invasive
versus open esophagectomy for cancer: a systematic
review and meta-analysis. Minerva Chir. 2009
Apr;64(2):121-33.
Nagpal K,Ahmed K,Vats A,Yakoub D, James D,Ashrafian
H, Darzi A, Moorthy K,Athanasiou T. Is minimally invasive
surgery beneficial in the management of esophageal
cancer? A meta-analysis . Surg Endosc. 2010
Jul;24(7):1621-9.
Sgourakis G, Gockel I, Radtke A, Musholt TJ,Timm S, Rink
A,Tsiamis A, Karaliotas C, Lang H Minimally invasive
versus open esophagectomy: meta-analysis of
outcomes. ) Dig Dis Sci. 2010 Nov;55(11):3031-40

6. Randomised Trials
 Miguel A. Cuesta, Surya S.A.Y. Biere, Mark I. van Berge
Henegouwen,and Donald L. van der Peet
Randomised trial, Minimally Invasive Oesophagectomy versus open
oesophagectomy for patients with resectable oesophageal cancer.
J Thorac Dis. 2012 October; 4(5): 462–46
 Open versus laparoscopically-assisted oesophagectomy for cancer:
a multicentre randomised controlled phase III trial - the MIRO trial.
Briez N, Piessen G, Bonnetain F, Brigand C, Carrere N, Collet
D, Doddoli C, Flamein R, Mabrut JY, Meunier B, Msika S, Perniceni
T, Peschaud F, Prudhomme M,Triboulet JP, Mariette C.
BMC Center 2011 Jul 23;11:310

7. Our Experience
( retrospective 10 years )

8. Esophagectomy (89)
0
2
4
6
8
10
12
14
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Open MIE

9. Etiology (MIE 47)
0
5
10
15
20
25
30
35
40
45
Malignancy Achlasia Cardia Binign Stricture

10. MIE
0
5
10
15
20
25
30
35
40
45
McKeown Ivor Lewis

11. Port Position

12. Port Position

13. Thoraco Laparoscopic Esophagectomy

14. Ivor Lewis Esophagectomy

15. Operative Time
0
100
200
300
400
500
600
700
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
MIE
OPEN

16. Blood Loss
0
200
400
600
800
1000
1200
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
MIE
OPEN

17. ICU Stay
0
2
4
6
8
10
12
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
MIE
OPEN

18. Hospital Stay
0
2
4
6
8
10
12
14
16
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
MIE
OPEN

19. Lymph NodeYield
0
5
10
15
20
25
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
MIE
OPEN

20. 0
0.5
1
1.5
2
2.5
3
3.5
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
MIE
Open
Major complications
- bleeding requiring major transfusion
- major leak requiring interventions
- respiratory complications requiring ventilation
- Thoracic duct injury
- RLN injury

21. Mortality
 5/89 30 day mortality
 1/47 MIE (pneumonia with septic
shock)
 4/42 Traditional ( Gastric conduit leak,
Thoracic duct injury,Thoracic
anastomosis leak, Pneumonia with sever
sepsis )

22. Summary
 Minimally invasive technique very well
feasible
 Immediate outcome better in MIE
 Prone position with double lung
anesthesia has less respiratory
complications
 Oncological superiority is yet to be
validated in prospective randomised trials

23. ThankYou