Reduction in the time of surgical procedures via a safe one-step disinfection modification to the minimally invasive McKeown esophagectomy.

Abstract

The standard technique for McKeown's minimally invasive esophagectomy (MIE) involves a three-stage procedure that requires repositioning and secondary skin disinfection within the transition. Prolonged surgical times such as lobectomy and hysterectomy may be associated with an increased incidence of post-surgical complications. We introduced a one-step disinfection technique designed to facilitate esophageal cancer resection of oesophageal cancer by retrospectively analyzing 63 patients with oesophageal cancer who underwent MIE by the same surgeon. In this modified procedure, the patient is initially placed in a left semiprone position, while the region designated for disinfection includes the neck, the right arm, the right side of the chest, and an abdominal area extending to the anterior left axillary line. Upon completion of thoracoscopic process, the sheet beneath the body is dragged toward the direction of the ventral side, and subsequently, the body is rotated into the supine position, after which abdominal manipulation continues. Re-disinfection and reapplication of sterile towels for the surgical area are not necessary during the repositioning. Patient demographics and perioperative clinical data, including a median total surgical time of 261 minutes (range, 241-289 minutes), anastomotic leaks in 3 (4.8%) patients, pneumonia in 7 (11.1%) patients, and incisional infections in 1 (1.6%) patient, demonstrated that one-step disinfection technique is safe and simplifies the transition between thoracic manipulation and abdominal manipulation in minimally McKeown esophagectomy, reducing the surgical time.