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Chylothorax is a serious complication of transthoracic esophagectomy. Intraoperative thoracic duct (TD) identification represents a possible tool for preventing or repairing its lesions, and it is most of the time difficult, even during high-definition thoracoscopy. The aim of the study is to demonstrate the feasibility of using near-infrared fluorescence-guided thoracoscopy to identify TD anatomy and check its intraoperative lesions during minimally invasive esophagectomy. A 0.5 mg/kg solution of indocyanine green (ICG) was injected percutaneously in the inguinal nodes of 19 patients undergoing minimally invasive esophagectomy in a prone position, before thoracoscopy. TD anatomy and potential intraoperative lesions were checked with the KARL STORZ OPAL1® Technology. In all of the 19 patients where transthoracic esophagectomy was feasible, the TD was clearly identified after a mean of 52.7 minutes from injection time. The TD was cut for oncological radicality in two patients, and it was successfully ligated under the ICG guide. No postoperative chylothorax or adverse reactions from the ICG injection occurred. The TD identification with indocyanine green fluorescence during minimally invasive esophagectomy is a simple, effective, and non-time-demanding tool; it may become a standard procedure to prevent postoperative chylothorax. [ABSTRACT FROM AUTHOR]

Three α-elicitins, named hibernalin1, hibernalin2 and hibernalin3 (hib1, hib2 and hib3, respectively), were isolated by reverse phase-low-pressure liquid chromatography from culture filtrates of Phytophthora hibernalis Carne 1925, the causal agent of citrus lemon brown rot. Hib1 proved to be identical to syringicin previously isolated from culture filtrates of Phytophthora syringae. Hib2 and hib3 shared the same primary structure with hib1, but contained, at position 50, Met sulphoxide or sulphone, respectively. By SDS–PAGE, the three proteins showed the same electrophoretic mobility, corresponding to about 10 kDa. Exact Mr values were obtained by MALDI-TOF-MS (10,194.82 for hib1, 10,209.33 for hib2 and 10,223.80 for hib3), while by ESI-MS an Mr value of 10,194.90 was found for hib1 and no results for hib2 and hib3. The hibernalin forms showed a high propensity to self-association, after exposure to acetonitrile. Hib1 showed to be active in both the hypersensitivity response and electrolytes leakage assays; the sample containing hib1 and hib2 was only weakly active in the first assay and inactive in the second assay, while the sample containing all three hibernalin forms proved to be inactive in both tests. It is proposed that the different activities of the three hibernalin samples could be very likely attributed to both Met50 oxidation and aggregation. [ABSTRACT FROM PUBLISHER]

Background Minimally invasive esophagectomy (MIE) has been met with increased interest for the surgical treatment of esophageal cancer. One critical obstacle for the implementation of MIE has been the intrathoracic anastomosis. In this study, we describe a technique of Ivor Lewis MIE in prone position and we present the short-term outcomes of this procedure compared to the McKeown MIE. Methods A total of 53 consecutive patients with with an Adenocacinoma of the gastroesophageal junction (GEJ) or the distal esophagus esophageal who had undergone MIE were included in the analysis. The clinical outcomes were analized and compared between the 24 patients treated with thoracoscopic two field Ivor Lewis (IL) MIE with intrathoracic stapled End-to-side anastomosis and 29 patients treated with thoracoscopic three field McKeown (McK) MIE with cervical stapled End-to-side anastomosis. The main outcome was postoperative respiratory complications. The secondary outcomes included the length of the operation, blood transfusion, number of dissected lymph nodes, postoperative morbidities and mortality. Results No statistical difference was found between postoperative respiratory complications (p: 0, 475), operative time (p: 0395), Lymph node retrieved (p: 0864), blood transfusion (p: 0951), ICU stay (p: 0131), oral intake in days (p: 0592), post operative stay (p:0830), anastomotic leakage (p: 0669), overall morbidity (p:0400), mortality (p: 0267). Anastomotic stenosis were more frequent in the McKeown group (p: 0062). Conclusion The intrathoracic stapled end-to-side anastomosis technique seems to be feasible, safe, and easy to perform, associated with a limited postsurgical complication rate and a good functional outcome. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Benign lesions of the esophagus are rare, leiomyoma is the most common. Minimally invasive thoracoscopic enucleation is the currently best approache. We present our experience of thoracoscopic enucleation with patient in the prone position Methods Between June 2010 and December 2017 all patients referred to our Institute for symptomatic benign lesions of the esophagus underwent thoracoscopic enucleation in prone position. After single-lumen endotracheal intubation patients were placed in prone position. A right pneumothorax at 8 mmHg was created with a port at the apex of the scapula; two or three operative trocars were inserted in the right 5th and 9th intercostal spaces. The mediastinal pleura and the muscular layer over the lesion were incised and split using a coagulating hook. The lesions were carefully enucleated. The myotomy was closed with interrupted stitches. An intercostal drain was left in the right chest. Results 5 patients (3 males and 3 females) underwent thoracoscopic enucleation in prone position, without any conversion. Median operative time was 90 minutes (60–170), blood loss was minimal, there were no intraoperative or postoperative complications. 1 lesion was in the upper esophagus, 2 in the middle and 2 in the lower esophagus. The median post operative hospital stay was 9 days (9–11). Histopathology reveal 4 leiomyomas and 1 esophageal bronchogenic cyst. The median size of the lesions was 7.25 cm (3–9). In the follow up there weren't recurrence or other symptoms. Conclusion Prone thoracoscopic enucleation of benign lesions of the esophagus is safe and feasible also for lesions > 5 cm; it permits an ergonomic position and a wide, clean operative field. Double lung ventilation and less post operative pain can reduce pulmonary complications Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Description After laparoscopic gastric conduit creation the patient is placed in prone position, with single-lumen endotracheal intubation. A right pneumothorax at 8 mmHg is created with a port at the apex of the scapula; two operative trocars are inserted in the right 5th and 9th intercostal spaces. The esophageal dissection in performed with an en bloc linfadenectomy. The distal part of the esophagus is tied up with a loop; the esophagus in then divided with an electrocautery scissor. A manual purse-string is made in the proximal esophageal stump with a Prolene 2/0. The envil of a circular stapler is put inside the chest through a port or during the laparoscopic procedure opening the right pleura; so it is introduced in the esophageal stump and the purse-string is closed. The incision of the lower port is enlarged and a laparoscopic wound retractor device is inserted. The specimen and the gastric conduit are retrieved; the stapler is introduced trough the laparoscopic wound retractor tip and through a small gastrostomy in the gastric tube; the puncturing shaft is pulled out through the greater gastric curve. We ensure the gastric conduit to the stapler with a second envil; it is introduced in the chest. After opening the stapler and loosing the second envil we perfomed the esophago-gastric anastomosis. A linear stapler is used to remove the excess of the stomach with the gastrostomy. Some interrupted stitches fixed the anastomosis to the mediastinal pleura. Two right chest tubes are inserted. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Minimally invasive esophagectomy is performed with increasing frequency and proves to be a safe and effective surgical alternative to the open technique. Minimally invasive esophagectomy using thoracoscopic esophageal mobilization with the patient in prone position seems to offer some advantages with regard to surgeon ergonomics and clinical outcome. Methods Between July 2005 and December 2017, 156 patients underwent minimally invasive esophagectomy in the prone position at the authors' institutionin. Was performed 132 three field McKeown MIE (84,6%) with circular stapled cervical anastomosis and 24 two field Ivor Lewis MIE (15,4%) with circular stapled intrathoracic anastomosis; For four patients (2,6%) the colon was used for cervical anastomosis, and two patients (1,3%) had previously undergone left pneumonectomy because of lung cancer. The preoperative indication was squamous cell carcinoma for 100 patients (64,1%) and adenocarcinoma for 53 patients (33,9%). In three cases (1,9%), the histology of the specimen showed a squamous cell carcinoma with neuroendocrine differentiation. Neoadjuvant treatment was administered to 79 patients (50,6%) Results In 152 patients (97,4%) was performed esophagectomy using minimally invasive thoracic mobilization of the esophagus with the patient in prone position. In four cases (2,6%) an early thoracotomic conversion was necessary due to the presence of lung adhesions such that made it impossible to establish the pneumothorax. The mean operative time was 255 min (range: 130–420 min). The median intensive care unit stay was 2 days (range: 0–77 day), and the median postoperative hospital stay was 15 days (range: 8–79 day). The mean number of procured lymph nodes was 16 (range: 0–56 Ln). The perioperative pulmonary morbidity rate was 22,4%, and the perioperative mortality rate was 2.6%. An anastomotic leakage occurred in 13 patients (8,3%). Conclusion Minimally invasive esophagectomy is safe and technically feasible. It entails a lower mortality rate and a shorter hospital stay than those reported in most open series. Thoracoscopy with the patient in prone position offers results comparable with those obtained using other minimally invasive techniques.This technique shows considerable advantages such as improved surgeon ergonomics, increased operative field exposure, and satisfactory respiratory results. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]