How to Do It
Patient Position for a Synchronous Cervicothoracoabdominal Two-Team Esophagectomy

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Abstract

Cervicothoracoabdominal and cervicoabdominal approach are routinely adopted for total or subtotal esophagectomy. We propose a modification of the Nanson’s patient position to optimize sequential or simultaneous left cervicotomy, laparotomy, and eventual right thoracotomy with one or two surgical teams. This technique permits better control of the operative field for each phase of the procedure with coordinated operating of two surgical teams on the neck, abdomen, and chest.

(Ann Thorac Surg 1997;63:255–7)

Section snippets

Technique

The main feature of this technique is the possibility, by rotating the table on each side, of obtaining a horizontal supine patient position or a right chest up patient position as for a normal laparotomic or thoracotomic procedure.

The patient is positioned on the bed with a 30-degree tilt of the body on the left side (Fig. 1). The legs are positioned as for a right thoracotomic procedure. The right hand and forearm are gloved with a soft padding and the hand is tucked under the right loin (

Comment

Our variation of the Nanson’s position permits the operation to be carried out as if each step of the procedure were performed singularly and yet without redraping or repositioning of the patient. It maintains the advantage of shortening the operating time by means of a synchronous combined two-team operation. As opposed to the simultaneous thoracoabdominal approach described by Nanson, we suggest one team working on the neck and one on the abdomen, followed by simultaneous closure of the three

Acknowledgements

We thank Nadia Nuvoli for the excellent illustrations.

References (7)

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    Synchronous combined abdomino-thoraco-cervical esophagectomy

    Aust N Z J Surg

    (1975)
  • FG Pearson

    Synchronous combined abdominothoracocervical esophagectomy

  • SCS Chung et al.

    Two team synchronous esophagectomy

    Surg Gynecol Obstet

    (1990)
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