Efficacy of 3D Laparoscopy in Thoraco-Laparoscopic Esophagectomy for Caustic Esophageal Strictures

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Efficacy of 3D Laparoscopy in Thoraco-Laparoscopic Esophagectomy for Caustic Esophageal Strictures

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https://doi.org/10.54963/entu.v15i3.1424
Toktogaziev, B., Omorov, R., Kurmanbekov, N., Belekov, T., Karabaev, A., Sharshenbaeva, A., & Vityala, Y. (2025). Efficacy of 3D Laparoscopy in Thoraco-Laparoscopic Esophagectomy for Caustic Esophageal Strictures. ENT Updates, 15(3), 73–83. https://doi.org/10.54963/entu.v15i3.1424
Volume 15 Issue 3 (2025): In Progress
Copyright (c) 2025 Bakyt Toktogaziev, Rahatbek Omorov, Nurtilek Kurmanbekov, Tilek Belekov, Azamat Karabaev, Aizhamal Sharshenbaeva, Yethindra Vityala
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This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors

  • Bakyt Toktogaziev

    Department of Faculty Surgery named after Academician K.R. Ryskulova, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek 720020, Kyrgyzstan
  • Rahatbek Omorov

    Department of Faculty Surgery named after Academician K.R. Ryskulova, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek 720020, Kyrgyzstan
  • Nurtilek Kurmanbekov

    Department of Surgery, Educational and Scientific Medical Center, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek 720020, Kyrgyzstan
  • Tilek Belekov

    Department of Surgery, Educational and Scientific Medical Center, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek 720020, Kyrgyzstan
  • Azamat Karabaev

    Department of Surgery, Educational and Scientific Medical Center, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek 720020, Kyrgyzstan
  • Aizhamal Sharshenbaeva

    Department of Oncology, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek 720020, Kyrgyzstan
  • Yethindra Vityala

    Department of Pathology, International Higher School of Medicine, Bishkek 720054, Kyrgyzstan

Ingesting caustic substances can cause severe esophageal strictures, particularly in young adults. Thoraco-laparoscopic esophagectomy (TLE) is a minimally invasive surgical treatment for complex strictures when conservative methods fail. However, dense fibrosis and altered anatomy pose challenges for conventional laparoscopic surgical systems. This prospective comparative study evaluated the effectiveness of three-dimensional (3D) laparoscopic visualization in TLE for post-burn esophageal strictures. Twenty-eight patients aged 18–40 years with caustic-induced strictures were divided into two groups: Full High-Definition (HD) laparoscopy (n = 14) and 3D laparoscopy (n = 14). Intraoperative and postoperative outcomes were compared between the two groups. The 3D group had significantly shorter operative times (200 ± 10 min vs. 230 ± 20 min; p < 0.05), reduced blood loss (40 ± 8 ml vs. 60 ± 10 ml; p < 0.05), and lower anastomotic failure rates (7.1% vs. 21.4%; p < 0.05) than the Full HD group. Postoperative complications and hospital stay were lower in the 3D group, although the difference was not statistically significant. Surgeon feedback indicated better depth perception and precision with 3D systems. Macroscopic examination of the resected specimens confirmed severe fibrotic strictures, whereas postoperative imaging showed patent anastomoses. The results suggest that 3D laparoscopy enhances surgical efficiency and safety in TLE for post-caustic strictures by improving visualization of the fibrotic planes. Incorporating 3D systems into surgical practice and training can potentially improve outcomes and expand minimally invasive techniques for complex esophageal surgeries, particularly in resource-limited settings.

Keywords:

Caustic Injuries Esophageal Injuries Esophageal Strictures Endoscopic Dilation Thoraco-Laparoscopic Esophagectomy Post-Burn Strictures

References

  1. Andreoni, B.; Farina, M.L.; Biffi, R.; et al. Esophageal Perforation and Caustic Injury: Emergency Management of Caustic Ingestion. Dis. Esophagus. 1997, 10, 95–100.
  2. Tohda, G.; Sugawa, C.; Gayer, C.; et al. Clinical Evaluation and Management of Caustic Injury in the Upper Gastrointestinal Tract in 95 Adult Patients in an Urban Medical Center. Surg. Endosc. 2008, 22, 1119–1125.
  3. Cheng, H.T.; Cheng, C.L.; Lin, C.H.; et al. Caustic Ingestion in Adults: The Role of Endoscopic Classification in Predicting Outcome. BMC Gastroenterol. 2008, 8, 31.
  4. Arévalo-Silva, C.; Eliashar, R.; Wohlgelernter, J.; et al. Ingestion of Caustic Substances: A 15-Year Experience. Laryngoscope. 2006, 116, 1422–1426.
  5. Challine, A.; Maggiori, L.; Katsahian, S.; et al. Outcomes Associated with Caustic Ingestion among Adults in a National Prospective Database in France. JAMA Surg. 2022, 157, 112–119.
  6. Chirica, M.; Kelly, M.D.; Siboni, S.; E.; et al. Esophageal Emergencies: WSES Guidelines. World J. Emerg. Surg. 2019, 14, 26.
  7. Crain, E.F.; Gershel, J.C.; Mezey, A.P. Caustic Ingestions. Symptoms as Predictors of Esophageal Injury. Am. J. Dis. Child. 1984, 138, 863–865.
  8. Temiz, A.; Oguzkurt, P.; Ezer, S.S.; et al. Predictability of Outcome of Caustic Ingestion by Esophagogastroduodenoscopy in Children. World J. Gastroenterol. 2012, 18, 1098–1103.
  9. Methasate, A.; Lohsiriwat, V. Role of Endoscopy in Caustic Injury of the Esophagus. World J. Gastrointest. Endosc. 2018, 10, 274–282.
  10. Rana, S.S.; Bhasin, D.K.; Singh, K. Role of Endoscopic Ultrasonography (EUS) in Management of Benign Esophageal Strictures. Ann. Gastroenterol. 2011, 24, 280–284.
  11. Han, Y.; Cheng, Q.S.; Li, X.F.; et al. Surgical Management of Esophageal Strictures after Caustic Burns: A 30 Years of Experience. World J. Gastroenterol. 2004, 10, 2846–2849.
  12. Vandenplas, Y.; Hauser, B.; Devreker, T.; et al. A Biodegradable Esophageal Stent in the Treatment of a Corrosive Esophageal Stenosis in a Child. J. Pediatr. Gastroenterol. Nutr. 2009, 49, 254–257.
  13. Manfredi, M.A.; Clark, S.J.; Medford, S.; et al. Endoscopic Electrocautery Incisional Therapy as a Treatment for Refractory Benign Pediatric Esophageal Strictures. J. Pediatr. Gastroenterol. Nutr. 2018, 67, 464–468.
  14. Usta, M.; Erkan, T.; Cokugras, F.C.; et al. High Doses of Methylprednisolone in the Management of Caustic Esophageal Burns. Pediatrics 2014, 133, e1518–e1524.
  15. Katibe, R.; Abdelgadir, I.; McGrogan, P.; et al. Corticosteroids for Preventing Caustic Esophageal Strictures: Systematic Review and Meta-Analysis. J. Pediatr. Gastroenterol. Nutr. 2018, 66, 898–902.
  16. Kubo, N.; Ohira, M.; Yamashita, Y.; et al. The Impact of Combined Thoracoscopic and Laparoscopic Surgery on Pulmonary Complications after Radical Esophagectomy in Patients with Resectable Esophageal Cancer. Anticancer Res. 2014, 34, 2399–2404.
  17. Senkowski, C.K.; Adams, M.T.; Beck, A.N.; et al. Minimally Invasive Esophagectomy: Early Experience and Outcomes. Am. Surg. 2006, 72, 677–683.
  18. Zhang, Z.M.; Wang, Y.; Gao, Y.S.; et al. Minimally Invasive Esophagectomy for Esophageal Carcinoma: Clinical Analysis of 160 Cases. Chin. J. Gastrointest. Surg. 2012, 15, 934–937.
  19. Oshikiri, T.; Takiguchi, G.; Miura, S.; et al. Current Status of Minimally Invasive Esophagectomy for Esophageal Cancer: Is It Truly Less Invasive? Ann. Gastroenterol. Surg. 2018, 3, 138–145.
  20. Luketich, J.D.; Nguyen, N.T.; Weigel, T.; et al. Minimally Invasive Approach to Esophagectomy. JSLS. 1998, 2, 243–247.
  21. Guven, H.; Karahan, S.R.; Koc, B.; et al. Minimally Invasive 3-Field Esophagectomy with Cervical Single-Port Access. Surg. Laparosc. Endosc. Percutan. Tech. 2014, 24, e151–e154.
  22. Nguyen, N.T.; Hinojosa, M.W.; Smith, B.R.; et al. Minimally Invasive Esophagectomy: Lessons Learned from 104 Operations. Ann. Surg. 2008, 248, 1081–1091.
  23. Mariette, C.; Markar, S.R.; Dabakuyo-Yonli, T.S.; et al. Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer. N. Engl. J. Med. 2019, 380, 152–162.
  24. Sinha, R.Y.; Raje, S.R.; Rao, G.A. Three-Dimensional Laparoscopy: Principles and Practice. J. Minim. Access Surg. 2017, 13, 165–169.
  25. Feng, X.; Morandi, A.; Imvised, T.; et al. Three-Dimensional Versus Two-Dimensional Imaging in Adult Versus Pediatric Laparoscopy: A Simulator Box Study. J. Laparoendosc. Adv. Surg. Tech. A. 2015, 25, 1051–1056.
  26. Kyriazis, I.; Özsoy, M.; Kallidonis, P.; et al. Integrating Three-Dimensional Vision in Laparoscopy: The Learning Curve of an Expert. J. Endourol. 2015, 29, 657–660.
  27. Rebecchi, F.; Allaix, M.E.; Morino, M. Robotic Technological Aids in Esophageal Surgery. J. Vis. Surg. 2017, 3, 7.
  28. Amiri, R.; Zwart, M.J.W.; Jones, L.R.; et al. Surgeon Preference and Clinical Outcome of 3D Vision Compared to 2D Vision in Laparoscopic Surgery: Systematic Review and Meta-Analysis of Randomized Trials. Ann. Surg. Open. 2024, 5, e415.
  29. Zhan, S.; Zhu, Z.; Yu, H.; et al. Comparison of Therapeutic Effects Between Conventional 2D Laparoscopy and 3D Laparoscopy in the Treatment of Colorectal Cancer: A Systematic Review and Meta-Analysis. Am. Surg. 2024, 90, 3102–3112.
  30. Portale, G.; Bartolotta, P.; Azzolina, D.; et al. Laparoscopic Right Hemicolectomy with 2D or 3D Video System Technology: Systematic Review and Meta-Analysis. Int. J. Colorectal Dis. 2023, 38, 34.
  31. Zundel, S.; Lehnick, D.; Heyne-Pietschmann, M.; et al. A Suggestion on How to Compare 2D and 3D Laparoscopy: A Qualitative Analysis of the Literature and Randomized Pilot Study. J. Laparoendosc. Adv. Surg. Tech. A 2019, 29, 114–120.
  32. Luketich, J.D.; Pennathur, A.; Awais, O.; et al. Outcomes after Minimally Invasive Esophagectomy: Review of over 1000 Patients. Ann. Surg. 2012, 256, 95–103.
  33. Zureikat, A.H.; Postlewait, L.M.; Liu, Y.; et al. A Multi-Institutional Comparison of Perioperative Outcomes of Robotic and Open Pancreaticoduodenectomy. Ann. Surg. 2016, 264, 640–649.
  34. Smith, R.; Day, A.; Rockall, T.; et al. Advanced Stereoscopic Projection Technology Significantly Improves Novice Performance of Minimally Invasive Surgical Skills. Surg. Endosc. 2012, 26, 1522–1527.
  35. Spille, J.; Wenners, A.; von Hehn, U.; et al. 2D Versus 3D in Laparoscopic Surgery by Beginners and Experts: A Randomized Controlled Trial on a Pelvitrainer in Objectively Graded Surgical Steps. J. Surg. Educ. 2017, 74, 867–877.
  36. van Boeckel, P.G.; Siersema, P.D. Refractory Esophageal Strictures: What to Do When Dilation Fails. Curr. Treat. Options Gastroenterol. 2015, 13, 47–58.
  37. Ramasamy, K.; Gumaste, V.V. Corrosive Ingestion in Adults. J. Clin. Gastroenterol. 2003, 37, 119–124.
  38. Biere, S.S.; van Berge Henegouwen, M.I.; Maas, K.W.; et al. Minimally Invasive Versus Open Oesophagectomy for Patients with Oesophageal Cancer: A Multicentre, Open-Label, Randomised Controlled Trial. Lancet 2012, 379, 1887–1892.
  39. Charalabopoulos, A.; Davakis, S.; Paraskeva, P.; et al. Feasibility and Short-Term Outcomes of Three-Dimensional Hand-Sewn Esophago-Jejunal Anastomosis in Completely Laparoscopic Total Gastrectomy for Cancer. Cancers 2021, 13, 4709.
  40. Kluger, Y.; Ishay, O.B.; Sartelli, M.; et al. Caustic Ingestion Management: World Society of Emergency Surgery Preliminary Survey of Expert Opinion. World J. Emerg. Surg. 2015, 10, 48.
  41. Diana, M.; Marescaux, J. Robotic Surgery. Br. J. Surg. 2015, 102, e15–e28.
  42. Misra, M.C.; Bal, S.; Dewan, N.; et al. Laparoscopic Hernia Repair—What Are the Results? Ann. Acad. Med. 1996, 25, 737–741.
  43. Shen, R.W.; Zhang, W. Application of a Glasses-Free 3D Laparoscopic System in Radical Gastrointestinal Cancer Surgery. World J. Gastrointest. Surg. 2025, 17, 106311.
  44. Milsom, J.W.; Böhm, B.; Hammerhofer, K.A.; et al. A Prospective, Randomized Trial Comparing Laparoscopic Versus Conventional Techniques in Colorectal Cancer Surgery: A Preliminary Report. J. Am. Coll. Surg. 1998, 187, 46–54.
  45. Sørensen, S.M.; Savran, M.M.; Konge, L.; et al. Three-Dimensional Versus Two-Dimensional Vision in Laparoscopy: A Systematic Review. Surg. Endosc. 2016, 30, 11–23.
  46. Wang, Z.; Liang, J.; Chen, J.; et al. Three-Dimensional (3D) Laparoscopy Versus Two-Dimensional (2D) Laparoscopy: A Single-Surgeon Prospective Randomized Comparative Study. Asian Pac. J. Cancer Prev. 2020, 21, 2883–2887.
  47. van der Sluis, P.C.; Babic, B.; Uzun, E.; et al. Robot-Assisted and Conventional Minimally Invasive Esophagectomy Are Associated with Better Postoperative Results Compared to Hybrid and Open Transthoracic Esophagectomy. Eur. J. Surg. Oncol. 2022, 48, 776–782.
  48. Lupa, M.; Magne, J.; Guarisco, J.L.; et al. Update on the Diagnosis and Treatment of Caustic Ingestion. Ochsner J. 2009, 9, 54–59.

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