What is a minimally invasive esophagectomy?

Esophagectomy
A minimally invasive esophagectomy is a surgery that involves removing the entire esophagus or a part of it.

The esophagus is a tubular organ that connects the throat to the stomach. A minimally invasive esophagectomy is a surgery that involves removing the entire esophagus or a part of it. 

After the esophagus is removed, it is rebuilt from a part of the stomach or the large intestine. Most of the time, esophagectomy is done to treat cancer of the esophagus. This surgery may also be performed if the esophagus is no longer working to move food into the stomach (dysphagia).

Who performs an esophagectomy?

Esophagectomy is generally performed by thoracic (chest) and general surgeons. They work together, each handling one aspect of the surgery or the other.

How is a minimally invasive esophagectomy performed?

Minimally invasive esophagectomy is usually performed under general anesthesia.

  • The surgeon makes three to four small cuts in the upper belly, chest, or lower neck. These cuts are about 1 inch (2.5 cm) long.
  • The laparoscope is inserted through one of the cuts into the upper belly. The scope has a light and camera on the end. Video from the camera appears on a monitor in the operating room. This allows the surgeon to view the area being operated on. Other surgical tools are inserted through the other cuts.
  • The surgeon frees the esophagus from nearby tissue. Depending on how much of the esophagus is diseased, part or most of it is removed.
  • If part of the esophagus is removed, the remaining ends are joined together using staples or stitches. If most of the esophagus is removed, the surgeon reshapes the stomach into a tube to make a new esophagus. It is then joined to the remaining part of the esophagus.
  • During surgery, lymph nodes in the chest and belly are likely removed if cancer has spread there.
  • A feeding tube is placed in the small intestine, so the individual can be fed while recovering from surgery.

Some medical centers do this operation using robotic surgery. In this type of surgery, a small scope and other instruments are inserted through the small cuts in the skin. The surgeon controls the scope and instruments while sitting at a computer station and observing through a monitor.

What happens after a minimally invasive esophagectomy is performed?

After the procedure, most people stay in the hospital for seven to 14 days. The patient may spend one to three days in the intensive care unit (ICU) right after surgery.

  • The patient might be asked to sit on the side of the bed and walk on the same day or day after surgery.
  • Patients may not be able to eat for at least the first two to seven days after surgery. After that, they may start on a liquid diet. The patient will be fed through a feeding tube that was placed into the intestine during surgery.
  • Patients may be asked to wear special stockings on the feet and legs to prevent blood clots.
  • They might receive medications to prevent blood clots.
  • Patients are also given pain medicine, antibiotics, and other medications either intravenously or orally. 
  • They may be advised to do breathing exercises.
  • Patients might usually take eight to 10 weeks to recover after a minimally invasive esophagectomy.

What are the advantages of a minimally invasive esophagectomy procedure?

The advantages of minimally invasive esophagectomy include

  • Less postoperative pain
  • Faster recovery from surgery
  • Shorter hospital stay
  • A more rapid return to work and normal activities

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What are the common complications after a minimally invasive esophagectomy procedure?

Apart from general anesthesia complications (headache, nausea, drowsiness, etc.), patients may also have other complications, which include

  • Acid reflux
  • Infection
  • Injury to the stomach, intestines, lungs, or other organs during surgery
  • Leakage of the contents of the esophagus or stomach from the tube where the surgeon joined them together
  • Narrowing of the connection between the stomach and esophagus
  • Pneumonia

What is the prognosis after a minimally invasive esophagectomy procedure?

Most patients after a minimally invasive esophagectomy recover well and can have a fairly normal diet. After they recover, they will likely need to eat smaller portions and eat more frequently. This procedure has a high success rate, depending upon the reason why the surgery was performed. 

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Medically Reviewed on 7/1/2020
References
REFERENCES:

Minimally invasive esophagectomy: (https://emedicine.medscape.com/article/1965556-overview#a5).
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