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


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
Respiratory
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)