Patient position for a synhronous cervicothoracoabdominal two-team esophagectomy..

Background: Cervicothoracoabdominal and cervicoabdominal approach are routinely adopted for total or subtotal esophagectomy. We propose a modifi cation of the Nanson’s patient position to optimize sequential or simultaneous left cervicotomy, laparotomy, and eventual right thoracotomy with one or two surgical teams. Methods: 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. We use a surgical table that permits a 25-degree rotation on each side and maintains stability when the patient is in the horizontal supine position in which the entire body weight is completely off center with respect to the base of the bed. A two-team operation may be carried out with one team working on the abdomen and one on the neck. Results: 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. Disadvantages are only the extra set-up time and extra equipment. Discussion: This technique permits better control of the operative fi eld for each phase of the procedure with coordinated operating of two surgical teams on the neck, abdomen, and chest. Disclosure: All authors have declared no confl icts of interest.