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Background: Interest for minimal invasive approach of esophagus resection is increasing. Today, a minimally invasive transhiatal esophagectomy is possible and is accepted widespread. Since cardiopulmonary changes during laparoscopic dissection of the mediastinum has not been studied yet we assessed the anesthesiological consequences of pneumothorax during laparoscopic mediastinal dissection.Methods: In this case control study, 25 laparoscopically assisted transhiatal espohagus resections were compared with a control group consisting of 20 open transhiatal esophagus resections. Patient characteristics and intraoperative haemodynamic, respiratory, and ventilatory parameters were assessed.Results: The laparoscopic assisted procedure was performed successfully in 12 of the 20 patients. The duration of the laparoscopic assisted procedure, compared to the open group was significantly longer (p<0.05). Intraoperative blood loss was significantly less in the laparoscopic group (p<0.05). Mediastinal dissection resulted in entry of the pleura in 84% of the open and 93% of the laparoscopic assisted procedure. Carbonedioxide pneumothorax resulted in increased end-tidal CO2)and airway pressure levels and decreased lung compliance. Airway pressure showed a significant difference between the groups (p<0.05). Hemodynamic parameters did not differ between groups significantly. There were no differences in postoperative cardiopulmonary complications.Conclusions: Laparoscopic assisted transhiatal esophagectomy is a safe procedure and has no increased risk of postoperative cardiopulmonary complications compared to thr conventional approach. The anesthesiologist and the surgeon must be aware of the potential risk of pleural injury to manage cardiopulmonary compromises and minimize complications. [ABSTRACT FROM AUTHOR]

Background: Resection of the esophagus remains the only curative therapy for esophageal cancer. Conventional resections are right-side thoracotomy in combination with laparotomy, gastric tube creation, and the transhiatal approach according to Orringer. This study evaluated laparoscopically assisted transhiatal esophagus resection, which offers perfect visualization of the esophagus during mediastinal dissection without the necessity of a thoracotomy.Methods: In this study, 25 laparoscopically assisted transhiatal esophagus resections were compared with a historical control group consisting of 20 open transhiatal esophagus resections.Results: Nine laparoscopically assisted resections (36%) were converted to open procedures. The operating time was longer in the laparoscopically assisted group (300 vs 257 min; p < 0.05), but laparoscopically assisted esophagus resection was associated with less blood loss (600 vs 900 ml; p < 0.05) and shorter intensive care unit stay (1 vs 2 days; p < 0.05). There were no differences in morbidity, mortality, and hospital stay. During a shorter follow-up time for the laparoscopic group (17 vs 54 months), 11 patients (44%) in the laparoscopically assisted group and 10 (50%) patients in the open group had recurrence of the disease.Conclusions: Laparoscopically assisted transhiatal esophagus resection is a safe procedure with important advantages, as compared with the open procedure, such as less blood loss and shorter intensive care unit stay. At this point, the oncologic consequences are not clear. [ABSTRACT FROM AUTHOR]