Zusammenfassung
GRUNDLAGEN: Die konventionelle Ösophagektomie ist technisch aufwendig und ist mit einer entsprechenden Morbidität und Mortalität verbunden. METHODIK: Kritische Beurteilung der minimal invasiven Ösophagektomie. ERGEBNISSE: Die minimal invasive Ösophagektomie ist technisch anspruchsvoll, kann aber dazu beitragen, postoperative Komplikationen zu minimieren und die postoperative Lebensqualität zu verbessern. Die größte publizierte Serie zeigte eine Mortalität von 1,4 %, 11 % Anastomosendehiszenzrate und eine Verkürzung des Spitalsaufenthaltes nach minimal invasiver Ösophagektomie. Die Erfahrungen aus Pittsburg haben zu technischen Verbesserungen geführt, wie die Anlage eines engeren Magenpouches, Durchführung der Ivor-Lewis-Anastomose und eine radikalere Lymphknoten Resektion. SCHLUSSFOLGERUNGEN: In dieser Arbeit werden Hintergrund, Technik, Probleme und die Zukunft der minimal invasiven Ösophagektomie kritisch beleuchtet.
Summary
BACKGROUND: Esophagectomy can be a formidable operation even in experienced hands. METHODS: Critical appraisal towards minimal invasive esophagectomy. RESULTS: The complications are often lethal. Patients developing postoperative pneumonia after open esophagectomy have up to a 20% mortality rate. In an effort to reduce the morbidity and mortality of open esophagectomy, minimally invasive techniques have been developed. This is a challenging procedure technically, but offers the chance to lessen complications and improve survival. The learning curve is steep. Proper port placement, patient positioning, and facile use of mechanical staplers is mandatory. However, the largest published series to date of minimally invasive esophagectomies [MIE] showed a 1.4% mortality rate, an 11% anastamotic leak rate, and lowered lengths of stay. The evolving Pittsburgh experience has resulted in technical modifications like narrower gastric pouches, Ivor Lewis type anastamoses, and more complete lymph node resection. CONCLUSIONS: This paper discusses the background, techniques, challenges, and future direction for using this technique to treat esophageal disease.
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Ashrafi, A., Keeley, S., Shende, M. et al. Minimally invasive esophagectomy. Eur Surg 39, 141–150 (2007). https://doi.org/10.1007/s10353-007-0332-6
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DOI: https://doi.org/10.1007/s10353-007-0332-6