Assistant-based standardization of prone thoracoscopic esophagectomy

Yasuhiro Shirakawa, Kazuhiro Noma, Naoaki Maeda, Ryoichi Katsube, Shunsuke Tanabe, Toshiaki Ohara, Kazufumi Sakurama, Toshiyoshi Fujiwara

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Thoracoscopic esophagectomy in the prone position (TEPP) might enable solo-surgery in cases requiring resection of the esophagus and the surrounding lymph nodes due to the associated advantages of good exposure of the surgical field and ergonomic considerations for the surgeon. However, no one approach can be for all patients requiring extensive lymphadenectomy. We recently developed an assistant-based procedure to standardize exposure of the surgical field. Patients were divided into 1 of 2 groups: a pre-standardization group (n = 37) and a post-standardization group (n = 28). The thoracoscopic operative time was significantly shorter (p - 0.0037) in the post-standardization group (n = 28; 267±31min) than in the pre-standardization group (n = 37; 301±53min). Further, learning curve analysis using the moving average method showed stabilization of the thoracoscopic operative time after the standardization. No significant differences were found in the number of mediastinal lymph nodes dissected or intraoperative blood loss between the 2 groups. There were also no significant differences in the complication rate. Assistant-based surgery and standardization of the procedure resulted in a well-exposed and safe surgical field. TEPP decreased the operative time, even in patients requiring extensive lymphadenectomy.

Original languageEnglish
Pages (from-to)111-117
Number of pages7
JournalActa medica Okayama
Issue number2
Publication statusPublished - 2014


  • Prone position
  • Standardization
  • Thoracoscopic esophagectomy

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)


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