Esophagectomies vary~See videos below-Transthoracic - Transhiatal - Minimally Invasive - It could he

LorettaMarshall

Friends:  Below you will see different doctors telling how they perform the anastomosis.  So first here is the definition of the “anastomosis” as it relates to an Esophagectomy.  Believe me, this is only a “condensed collection” of documents I have in my WORD file.  These show how different Esophagectomies are performed.  I have more on file, but for the sake of time, I am placing these here for your “VIEWING PLEASURE!”  Different links will have a warning- “Graphic Video Viewer Discretion Advised”.  Enjoy!

(To tell you the truth, at first, I couldn’t watch much of the “blood & guts” without moving on, but now I can watch it all.)  It gives me a clearer understanding of the voluminous written explanations of how Esophagectomies are performed.  And I don’t mind telling you, I love Dr. James D. Luketich at the University of Pittsburgh Medical Center.  He pioneered the MIE.  Obviously he cannot perform every Esophagectomy solo.   UPMC ranks 6^th across the nation for Gastric Surgeries.  Naturally, the MIE is one of their “specialties”.  UPMC is a teaching hospital, and I know that Dr. Luketich observes and instructs as well as performs the surgeries himself.  You can always ask any surgeon who will actually be scheduled to perform my esophagectomy?   

Loretta (Wife of William) who had the totally laparoscopic Ivor Lewis Minimally Invasive Esophagectomy May 17, 2003 performed by Dr. James D. Luketich.  My husband’s last oncologist consultation was this past Thursday, August 31, 2017 and he remains cancer free.  We give God the credit for leading us to Dr. Luketich. 

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1.       http://medical-dictionary.thefreedictionary.com/esophageal+anastomosis

“a·nas·to·mo·sis -  (ə-năs′tə-mō′sĭs) - n. pl. a·nas·to·mo·ses (-sēz)

1. The connection of separate parts of a branching system to form a network, as of leaf veins, blood vessels, or a river and its branches.

 2. Medicine The surgical connection of separate or severed tubular hollow organs to form a continuous channel, as between two parts of the intestine…”

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 2.       https://www.youtube.com/watch?v=A3vC3hy8XYw

18 minute video tape – Very informative

Esophageal Surgery:  Ask Dr. Blair Marshall

“Chief of Thoracic Surgery at MedStar Georgetown University Hospital specializes in all of the chest including lung and esophageal cancers and has pioneered and published many minimally invasive techniques that save patients on pain and recovery time.”

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(My note:  Example of an Ivor Lewis Transthoracic Esophagectomy (TTE).  You can see why it is called OPEN!  Often the doctor whom one chooses to see will determine the type of Esophagectomy that will be performed.  As Dr. Blair Marshall says in the above video question and answer session, it takes more training to perform the Ivor Lewis Minimally Invasive Esophagectomy.  But often, the surgeon has not updated his skills to learn how to perform the Ivor Lewis Minimally Invasive Esophagectomy (MIE).  So the first question one should ask is, What type of Esophagectomy are you trained to perform?)

Unfortunately there is no sound for this particular video.  But the part you need to see is that all this surgery is “done OPEN!”]

3.       https://www.youtube.com/watch?v=wSSWAcgUABw

17:42 minute video - TRANSTHORACIC SUBTOTAL ESOPHAGECTOMY (IVOR LEWIS TYPE PROCEDURE) (OPEN)

Dr. Ilya Gotsadze/Surgical Oncology/ - Published – Feb. 22, 2014

“Surgery for cancer of the esophagus is one of the most complex, requiring the ability to operate in the abdominal and thoracic cavities.  In surgery for cancer the knowledge of anatomy, ability to work in anatomical layers is an important prerequisite to perform radical surgery.

The removal of the tumor in a single bloc with fatty tissue containing the regional lymph nodes is the main task of this intervention.  In this film, I tried to focus on the technical aspects of the operation and to demonstrate the manual surgical principles.

The film shows the methodology of subtotal transthoracic esophagectomy with lymph node dissection (2F) in the abdominal and thoracic cavities, shows the main principles of work with anatomical tissues.  It performed for T3N0M0 esophageal cancer (squamous cell carcinoma). “

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5.        http://csn.cancer.org/node/244659

Patients here on the CSN site telling about their pain they endured as a result of the OPEN Esophagectomy.  There are two very large incisions.  That naturally has the potential for many more complications, as our friend “Paul61” will tell you.  He wasn’t aware of the MIE at the time of his Esophagectomy.  (See Reference 11 to get a good look at one man's incisions!"

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TRANSHIATAL (THE) ESOPHAGECTOMY - 22:16 minute video

Note the large neck incision on the right side of the neck.  This is a “hands-assisted” Transhiatal Esophagectomy.  (THE)    (For an MIE, Dr. Luketich uses an incision on the lower right hand side of the chest to avoid potential damage to the laryngeal nerves.  (Voice Box)

6.       https://www.youtube.com/watch?v=oItauetshNQ&t=209s

Covidienpic – published on May 4, 2011—

Laparoscopic Transhiatal Esophagectomy featuring Mary S. Maish, MD, Assistant Professor of Surgery, Division of Thoracic Surgery, David Geffen School of Medicine, UCLA, Director, UCLA Center for Esophageal Disorders (SDMK13cd0800258)

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MINIMALLY INVASIVE ESOPHAGECTOMY (MIE)

7.       https://www.youtube.com/watch?v=hx4hS21AbuI&feature=related

[My note:  This is a fantastic surgeon.  If you live on the West Coast, check Dr. Ninh Nguyen out)

46.56 min. video – shows different stages of the surgery (not just the anastomosis that some surgeons lecture on in a conference in Florida.

This Dr. Ninh Nguyen practiced with Dr. James D. Luketich in the mid 90’s when Dr. Luketich first pioneered the Ivor Lewis Minimally Invasive Esophagectomy.

DUE TO THE GRAPHIC NATURE OF THIS VIDEO, VIEWER DISCRETION IS ADVISED

Minimally Invasive Esophagectomy featuring Ninh T. Nguyen, MD, Professor of Surgery Chief, Division of Gastrointestinal Surgery, University of California, Irvine Medical center.

Incidentally, you will note that Dr. Nguyen prefers his patients not have a G-tube as part of their pre-op treatment program.  That compromises the  stomach that is going to be used for the new gastric tube.  That is why we always stress the "J" tube if someone is unable to swallow prior to surgery.    (Jejunostomy tube named thus because it is implanted in the second section of the small intestine, the Jejunum.)  EC patients will have a "J" tube implanted in the Jejunum as part of the surgery.  This feeding tube is necessary to counteract the weight loss that most often occurs during the first few months post surgery.  My husband lost 60# during the first 9 months.  At time of surgery, he weighed in at 275.  In 9 months post surgery he weighed 215, and has stayed in the weight range of 205-215 since 2003. Weight gain or loss will vary with each patient, but weight loss is "normal" after surgery, because oral food intake is "minimal" for quite some time.  Sleeping elevated, and eating several "small" meals a day will be part of the "new normal" for post-surgical patients.  

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MINIMALLY INVASIVE ESOPHAGECTOMY – Dr. Dawn Jaroszewski

8.      https://www.bing.com/videos/search?q=Dr.+Dawn+Jaroszewski&view=detail&mid=8FDC7F7169CE163E4F9D8FDC7F7169CE163E4F9D&FORM=VIRE

Lectures from the 2014 General Thoracic Surgical Club

24:41 Lecture  - ADVANTAGES OF MIE VERSUS OPEN ESOPHAGECTOMY

• Less blood loss
• Shorter ICU stay and overall hospitalization
• Less pain & narcotic use
• Lower incidence of respiratory complications

She explains the benefit of making a chest anastomosis as opposed to the neck incision  to avoid risk of recurrent laryngeal nerve injury in neck – avoids risk of PO dysphagia due to neck dissection stricture (15% vs. 45%) and leak (10% vs 25%.

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9.       https://www.youtube.com/watch?v=cjB3w7ovgNE

16:44 Minute Video –

Dr. James Luketich Esophageal Anastomosis:  How I Do It.

MINIMALLY INVASIVE ESOPHAGECTOMY (MIE)

Lectures from the 2013 meeting of the General Thoracic Surgical Club’s 26^th annual meeting in Naples, FL – Published on May 31, 2013

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10.   https://www.youtube.com/watch?v=q1yJb6vxzcA&t=9s

TRANSHIATAL ESOPHAGECTOMY (THE)

Dr. Mark Orringer tells us how he performs the Esophageal Anastomosis

11:21 minute video

He speaks at the same 2013 meeting of the General Thoracic Surgical Club’s 26^th annual meeting in Naples, FL – He operates at the University of Michigan

This is really technical, but you will be able to see how one type of Esophagectomy differs from another.

 The three basic types are the Ivor Lewis Transthoracic (Esophagectomy (TTE) – 2 large incisions

The Transhiatal Esophagectomy (THE) has some “hands on” surgery involved as you can see with the female surgeon, Dr. Mary Maish.

And then of course, totally laparoscopic IVOR LEWIS MINIMALLY INVASIVE ESOPHAGECTOMY (MIE)

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11.  https://www.youtube.com/watch?v=VSI2_3WDFrw&feature=related

This one just makes us thankful we all had our esophagectomies here in the United States.  This is how an OPEN Ivor Lewis was done in Russia in January 2010 for Esophageal Cancer T3N1M0.  Surgeon Oleg Kshivets is a surgeon in Russia. 

Note the 2:02 minute mark forward to get a good view of the "incisions" ! You can see the two large incisions and the man’s stitches.  Yes he made it out alive.  Anyone who has the “open” Ivor Lewis will have these two large incisions.

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helpingsisinlaw

Loretta, 

Loretta, 

This is amazing.  I really wish we could come up with a list of surgeons in the U.S. that have experience with the MIE that Dr Nguyen's video displays.  

T