Difference between revisions of "Transhiatal esophagectomy"

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{{Infobox surgical case reference
{{Infobox surgical case reference
| anesthesia_type =  
| anesthesia_type = General
| airway =  
| airway = 8-O ETT
| lines_access =  
| lines_access = Large bore PIV
| monitors =  
Arterial Line
NG-tube
| monitors = Standard
Arterial Line
| considerations_preoperative =  
| considerations_preoperative =  
| considerations_intraoperative =  
| considerations_intraoperative =  
| considerations_postoperative =  
| considerations_postoperative = Anastamotic leak
}}
}}


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


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|Respiratory
|Pulmonary
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|-
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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 ===


=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
* EKG leads on back of shoulders to facilitate neck prep


=== 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 ===
 
* 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. --> ===
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=== 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. --> ===


=== 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. --> ===
* Supine with both arms tucked
 
=== Maintenance and surgical considerations ===
 
===== Abdominal laparoscopy: =====
 
===== Gastric conduit creation: =====
 
===== Esophageal transection: =====
 
===== Gastric pull-through: =====
 
* Watch peak and plateau pressures for signs of pneumothorax
* Compression of RA may cause sudden hypotension
 
===== 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). --> ==
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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
|}
|}


Latest revision as of 21:46, 21 February 2022

Transhiatal esophagectomy
Anesthesia type

General

Airway

8-O ETT

Lines and access

Large bore PIV Arterial Line NG-tube

Monitors

Standard Arterial Line

Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative

Anastamotic leak

Article quality
Editor rating
Unrated
User likes
0

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.[1] With advances in laparoscopic and robotic surgical techniques, the transhiatal esophagestomy has been increasing in popularity once again.

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

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

Regional and neuraxial techniques

  • Epidural for post-operative pain control

Intraoperative management

Monitoring and access

  • Standard ASA Monitors
  • Arterial line

Induction and airway management

Positioning

  • Supine with both arms tucked

Maintenance and surgical considerations

Abdominal laparoscopy:
Gastric conduit creation:
Esophageal transection:
Gastric pull-through:
  • Watch peak and plateau pressures for signs of pneumothorax
  • Compression of RA may cause sudden hypotension
Anastamosis:
  • Avoid excessive vasopressors to uphold integrity of anastamosis site

Emergence

Postoperative management

Disposition

Pain management

Potential complications

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

Procedure variants

  • Very few series have been published comparing robotic and laparoscopic approach.
Laparoscopic Robotic
Unique considerations
Position Supine Supine; arms tucked
Surgical time 279min[2] 267-311min
EBL 88mL[2] 54-100mL
Postoperative disposition
Pain management Epidural
Potential complications Pulmonary

Anastamotic leak (9-33%)

Vocal cord palsy (5-30%)

Length of Stay 9.2 days[2] 9-10 days

References

  1. ↑ Nottingham, James M.; McKeown, David G. (2021), "Transhiatal Esophagectomy", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32644622, retrieved 2021-06-17
  2. ↑ 2.0 2.1 2.2 Seto, Yasuyuki; Mori, Kazuhiko; Aikou, Susumu (2017-09). "Robotic surgery for esophageal cancer: Merits and demerits". Annals of Gastroenterological Surgery. 1 (3): 193–198. doi:10.1002/ags3.12028. ISSN 2475-0328. PMC 5881348. PMID 29863149. Check date values in: |date= (help)

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