Difference between revisions of "Ivor Lewis esophagectomy"
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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 | ||
| Line 12: | Line 12: | ||
== Preoperative management == | == 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. --> === | === 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 52: | Line 19: | ||
* Double-lumen tube (left) / bronchial blocker with SLT | * 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. --> === | ||
* Thoracic epidural | |||
== Intraoperative management == | == Intraoperative management == | ||
| Line 66: | Line 33: | ||
* 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 | ||
* NGT placed after airway management | |||
=== 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. --> === | ||
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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 | * A cervical anastomosis is performed and esophagus and stomach returned to mediastinum | ||
| Line 96: | Line 64: | ||
=== 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). --> == | ||
| Line 113: | Line 87: | ||
|Position | |Position | ||
| | | | ||
|Supine | |Supine followed by left | ||
lateral decubitus | lateral decubitus | ||
Revision as of 13:27, 2 September 2021
Ivor Lewis esophagectomy
| Anesthesia type |
General |
|---|---|
| Airway |
DLT / bronchial blocker |
| Lines and access |
Large PIV, arterial line, NG tube |
| Monitors |
Standard, arterial line |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Provide a brief summary of this surgical procedure and its indications here.
Preoperative management
Operating room setup
- Arterial line +/- flowtrack (ideally on left arm)
- Fluid warmer
- Double-lumen tube (left) / bronchial blocker with SLT
Regional and neuraxial techniques
- Thoracic epidural
Intraoperative management
Monitoring and access
- Invasive hemodynamic monitoring
- Large bore IV access
Induction and airway management
- 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
- NGT placed after airway management
Positioning
- Start in supine position if EGD is used at the beginning of the case
- Patient will be later positioned to left lateral decubitus for the thoracic portion of the resection
Maintenance and surgical considerations
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 anastomosis is performed and esophagus and stomach returned to mediastinum
Emergence
Postoperative management
Disposition
- Post-op ICU
Pain management
- Epidural
Potential complications
- Anastomotic leak
- Vocal cord paresis
- Recurrent laryngeal nerve injury
- Morbidity requiring re-operation
- Mortality
Procedure variants
| Open | Laparoscopic | Robotic | |
|---|---|---|---|
| Unique considerations | |||
| Position | Supine followed by left
lateral decubitus |
||
| Surgical time | |||
| EBL | |||
| Postoperative disposition | ICU | ICU or ERAS | ICU or ERAS |
| Pain management | Thoracic Epidural | Thoracic Epidural | Thoracic Epidural |
| Potential complications | Anastamotic leak (4.3%)
Vocal cord paresis (0.9%) Mortality (1.68%)[1] |
References
- ↑ Luketich, James D.; Pennathur, Arjun; Awais, Omar; Levy, Ryan M.; Keeley, Samuel; Shende, Manisha; Christie, Neil A.; Weksler, Benny; Landreneau, Rodney J.; Abbas, Ghulam; Schuchert, Matthew J. (2012-07). "Outcomes after minimally invasive esophagectomy: review of over 1000 patients". Annals of Surgery. 256 (1): 95–103. doi:10.1097/SLA.0b013e3182590603. ISSN 1528-1140. PMC 4103614. PMID 22668811. Check date values in:
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Top contributors: Nirav Kamdar and Olivia Sutton