The application of two instrument nurses’ cooperation model in the inflatable mediastinoscopy combined with laparoscopic radical resection of esophageal cancer: A multicenter retrospective study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Jiao ¹ , WANG Mengyao ² , XU Nuo ² , YAO Shuhuan ² , SUN Xiang ² , ZHU Ziyin ² ,  WEI Haitao ¹ ,  LI Li ^1,2

1. Department of Thoracic Surgery, Huaihe Hospital, Henan University, Kaifeng, 475099, Henan, P. R. China;
2. Chronic Disease Research Institute, School of Nursing and Health, Henan University, Kaifeng, 475001, Henan, P. R. China;

Corresponding?author：

WEI Haitao, Email: taoge9885@163.com; LI Li, Email: 10210051@vip.henu.edu.cn

Keywords：

Esophageal cancer; inflatable mediastinoscopy synchronous laparoscopic; radical resection of esophageal carcinoma; surgical cooperation; instrument nurse

DOI：

10.7507/1007-4848.202510025

Video：

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Objective To investigate the application effect of dual-instrument nurse teamwork in concurrent thoracoscopic and laparoscopic radical resection for esophageal cancer using an inflatable mediastinoscopy. Methods A retrospective analysis was conducted on surgical data of patients who underwent concurrent thoracoscopic and laparoscopic radical resection for esophageal cancer using an inflatable mediastinoscopy between 2021 and 2024 at five domestic hospitals by the same surgical team. Patients were divided into an observation group (two instrument nurses working simultaneously) and a control group (one instrument nurse working independently) based on the number of instrument nurses involved. After propensity score matching (1:1), the baseline characteristics, perioperative parameters, complication rates, postoperative pulmonary function status, immune stress response indicators, and surgical coordination quality were compared between groups. Results A total of 480 patients were enrolled, including 287 males and 193 females with a mean age of (53.90±7.81) years. After propensity score matching, 224 patients were analyzed per group. The operation time in the observation group was significantly shorter than that in the control group [(84.32±19.77) min vs. (95.23±29.54) min, P<0.001]. Compared with the control group, the observation group demonstrated reduced intraoperative blood loss and postoperative drainage volume, earlier first flatus time, oral intake time, and initial ambulation time, lower pain scores at 24 hours postoperatively, and decreased overall complication rates (all P<0.05). However, no significant difference was observed in the number of dissected lymph nodes between groups (P>0.05). Postoperative pulmonary function indicators were significantly higher in the observation group (P<0.05). Immune and stress response markers were markedly lower in the observation group (P<0.05), while the overall surgical coordination quality score was significantly higher (P<0.001). Conclusion Dual-instrument nurse teamwork during concurrent thoracoscopic and laparoscopic radical resection for esophageal cancer using an inflatable mediastinoscopy optimizes surgical workflow efficiency and quality, thereby promoting postoperative patient recovery.

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2.	Teng Y, Xia C, Cao M, et al. Esophageal cancer global burden profiles, trends, and contributors. Cancer Biol Med, 2024, 21(8): 656-666.
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5.	Wei HT, Zhang S, Liu YY, et al. Evaluation of the clinical effect of inflatable mediastinoscopy synchronous laparoscopic radical resection of esophageal cancer: a comparative study. Eur J Med Res, 2025, 30(1): 287.
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7.	Koch A, Burns J, Catchpole K, et al. Associations of workflow disruptions in the operating room with surgical outcomes: a systematic review and narrative synthesis. BMJ Qual Saf, 2020, 29(12): 1033-1045.
8.	Aouicha W, Tlili MA, Limam M, et al. Evaluation of the impact of intraoperative distractions on teamwork, stress, and workload. J Surg Res, 2021, 259: 465-472.
9.	Bellandi T, Cerri A, Carreras G, et al. Interruptions and multitasking in surgery: a multicentre observational study of the daily work patterns of doctors and nurses. Ergonomics, 2018, 61(1): 40-47.
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13.	Li B, Zhang Y, Miao L, et al. Esophagectomy with three-field versus two-field lymphadenectomy for middle and lower thoracic esophageal cancer: long-term outcomes of a randomized clinical trial. J Thorac Oncol, 2021, 16(2): 310-317.
14.	Hara K, Kuroki T, Fukuda M, et al. Effects of simulation-based scrub nurse education for novice nurses in the operating room: a longitudinal study. Clin Simul Nurs, 2022, 62: 12-19.
15.	U?ak A, Cebeci F. Competency perceptions of operating room nurses and opinions of the surgical team on factors facilitating competency acquisition: a mixed-methods study. J Eval Clin Pract, 2025, 31(5): e70233.
16.	Fang L, Xiao KP, Zhu HY, et al. Implementing '6S' nursing management in sterilization and supply centers: enhancing surgical instrument quality and work efficiency. Risk Manag Healthc Policy, 2025, 18: 1099-1108.
17.	Wagner L, Kolb S, Looschen C, et al. Versatile end effector for laparoscopic robotic scrub nurse. Int J Comput Assist Radiol Surg, 2023, 18(9): 1589-1600.
18.	Jang HJ, Lee SM. Influence of surgery preparation time on patient outcomes. J Nurs Manag, 2024, 2024: 6753210.
19.	von Vogelsang AC, Swenne CL, Gustafsson B, et al. Operating theatre nurse specialist competence to ensure patient safety in the operating theatre: a discursive paper. Nurs Open, 2020, 7(2): 495-502.
20.	Ioannidis O, Anestiadou E, Koltsida A, et al. Optimizing perioperative care in esophageal surgery: the European perioperative medical networking (EUPEMEN) collaborative for esophagectomy. Diseases, 2025, 13(8): 237.
21.	Kikuchi H, Booka E, Hiramatsu Y, et al. Essential updates 2022/2023: recent advances in perioperative management of esophagectomy to improve operative outcomes. Ann Gastroenterol Surg, 2024, 8(6): 966-976.
22.	Ma Y, Wu H, Wei X, et al. Comparison of different pain management strategies during the perioperative period of esophageal squamous cell carcinoma: a retrospective cohort study. Perioper Med (Lond), 2025, 14(1): 2.
23.	Hoelzen JP, Sander KJ, Sesia M, et al. Robotic-assisted esophagectomy leads to significant reduction in postoperative acute pain: a retrospective clinical trial. Ann Surg Oncol, 2022, 29(12): 7498-7509.
24.	Ye H, Wang X, Li X, et al. Effect of single-port inflatable mediastinoscopy simultaneous laparoscopic-assisted radical esophagectomy on respiration and circulation. J Cardiothorac Surg, 2021, 16(1): 288.
25.	N?rskov J, Skaarup SH, Bendixen M, et al. Diaphragmatic dysfunction is associated with postoperative pulmonary complications and phrenic nerve paresis in patients undergoing thoracic surgery. J Anesth, 2024, 38(3): 386-397.
26.	Chuang KH, Lai HH, Chen Y, et al. Improvement of surgical complications using single-lumen endotracheal tube intubation and artificial carbon dioxide pneumothorax in esophagectomy: a meta-analysis. J Cardiothorac Surg, 2021, 16(1): 100.
27.	Hirose M, Okutani H, Hashimoto K, et al. Intraoperative assessment of surgical stress response using nociception monitor under general anesthesia and postoperative complications: a narrative review. J Clin Med, 2022, 11(20): 6158.
28.	Cui B, Peng F, Lu J, et al. Cancer and stress: NextGen strategies. Brain Behav Immun, 2021, 93: 368-383.
29.	Jang HJ, Lee SM. Influence of surgery preparation time on patient outcomes. J Nurs Manag, 2024, 2024: 6753210.
30.	Sandelin A, Kalman S, Gustafsson B. Prerequisites for safe intraoperative nursing care and teamwork-operating theatre nurses' perspectives: a qualitative interview study. J Clin Nurs, 2019, 28(13-14): 2635-2643.

1. Yang H, Wang F, Hallemeier CL, et al. Oesophageal cancer. Lancet, 2024, 404(10466): 1991-2005.
2. Teng Y, Xia C, Cao M, et al. Esophageal cancer global burden profiles, trends, and contributors. Cancer Biol Med, 2024, 21(8): 656-666.
3. Deboever N, Jones CM, Yamashita K, et al. Advances in diagnosis and management of cancer of the esophagus. BMJ, 2024, 385: e074962.
4. Mann C, Berlth F, Hadzijusufovic E, et al. Minimally invasive esophagectomy: clinical evidence and surgical techniques. Langenbecks Arch Surg, 2020, 405(8): 1061-1067.
5. Wei HT, Zhang S, Liu YY, et al. Evaluation of the clinical effect of inflatable mediastinoscopy synchronous laparoscopic radical resection of esophageal cancer: a comparative study. Eur J Med Res, 2025, 30(1): 287.
6. Silver D, Kaye AD, Slakey D. Surgical flow disruptions, a pilot survey with significant clinical outcome implications. Curr Pain Headache Rep, 2020, 24(10): 60.
7. Koch A, Burns J, Catchpole K, et al. Associations of workflow disruptions in the operating room with surgical outcomes: a systematic review and narrative synthesis. BMJ Qual Saf, 2020, 29(12): 1033-1045.
8. Aouicha W, Tlili MA, Limam M, et al. Evaluation of the impact of intraoperative distractions on teamwork, stress, and workload. J Surg Res, 2021, 259: 465-472.
9. Bellandi T, Cerri A, Carreras G, et al. Interruptions and multitasking in surgery: a multicentre observational study of the daily work patterns of doctors and nurses. Ergonomics, 2018, 61(1): 40-47.
10. Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg, 2015, 262(2): 286-294.
11. 王靜, 孔娜, 張聚, 等. 基于服務質量差距模型的手術室手術配合質量評價量表的編制及信效度檢驗. 中華現代護理雜志, 2021, 27(15): 1998-2003.Wang J, Kong N, Zhang J, et al. Compilation and reliability and validity test of the Operating Room Operation Cooperation Quality Evaluation Scale based on the Service Quality Model. Chin J Mod Nurs, 2021, 27(15): 1998-2003.
12. Mansour AI, Reddy RM. Improving oncologic outcomes for esophageal cancer after open and minimally invasive esophagectomy. Ann Surg Oncol, 2022, 29(9): 5369-5371.
13. Li B, Zhang Y, Miao L, et al. Esophagectomy with three-field versus two-field lymphadenectomy for middle and lower thoracic esophageal cancer: long-term outcomes of a randomized clinical trial. J Thorac Oncol, 2021, 16(2): 310-317.
14. Hara K, Kuroki T, Fukuda M, et al. Effects of simulation-based scrub nurse education for novice nurses in the operating room: a longitudinal study. Clin Simul Nurs, 2022, 62: 12-19.
15. U?ak A, Cebeci F. Competency perceptions of operating room nurses and opinions of the surgical team on factors facilitating competency acquisition: a mixed-methods study. J Eval Clin Pract, 2025, 31(5): e70233.
16. Fang L, Xiao KP, Zhu HY, et al. Implementing '6S' nursing management in sterilization and supply centers: enhancing surgical instrument quality and work efficiency. Risk Manag Healthc Policy, 2025, 18: 1099-1108.
17. Wagner L, Kolb S, Looschen C, et al. Versatile end effector for laparoscopic robotic scrub nurse. Int J Comput Assist Radiol Surg, 2023, 18(9): 1589-1600.
18. Jang HJ, Lee SM. Influence of surgery preparation time on patient outcomes. J Nurs Manag, 2024, 2024: 6753210.
19. von Vogelsang AC, Swenne CL, Gustafsson B, et al. Operating theatre nurse specialist competence to ensure patient safety in the operating theatre: a discursive paper. Nurs Open, 2020, 7(2): 495-502.
20. Ioannidis O, Anestiadou E, Koltsida A, et al. Optimizing perioperative care in esophageal surgery: the European perioperative medical networking (EUPEMEN) collaborative for esophagectomy. Diseases, 2025, 13(8): 237.
21. Kikuchi H, Booka E, Hiramatsu Y, et al. Essential updates 2022/2023: recent advances in perioperative management of esophagectomy to improve operative outcomes. Ann Gastroenterol Surg, 2024, 8(6): 966-976.
22. Ma Y, Wu H, Wei X, et al. Comparison of different pain management strategies during the perioperative period of esophageal squamous cell carcinoma: a retrospective cohort study. Perioper Med (Lond), 2025, 14(1): 2.
23. Hoelzen JP, Sander KJ, Sesia M, et al. Robotic-assisted esophagectomy leads to significant reduction in postoperative acute pain: a retrospective clinical trial. Ann Surg Oncol, 2022, 29(12): 7498-7509.
24. Ye H, Wang X, Li X, et al. Effect of single-port inflatable mediastinoscopy simultaneous laparoscopic-assisted radical esophagectomy on respiration and circulation. J Cardiothorac Surg, 2021, 16(1): 288.
25. N?rskov J, Skaarup SH, Bendixen M, et al. Diaphragmatic dysfunction is associated with postoperative pulmonary complications and phrenic nerve paresis in patients undergoing thoracic surgery. J Anesth, 2024, 38(3): 386-397.
26. Chuang KH, Lai HH, Chen Y, et al. Improvement of surgical complications using single-lumen endotracheal tube intubation and artificial carbon dioxide pneumothorax in esophagectomy: a meta-analysis. J Cardiothorac Surg, 2021, 16(1): 100.
27. Hirose M, Okutani H, Hashimoto K, et al. Intraoperative assessment of surgical stress response using nociception monitor under general anesthesia and postoperative complications: a narrative review. J Clin Med, 2022, 11(20): 6158.
28. Cui B, Peng F, Lu J, et al. Cancer and stress: NextGen strategies. Brain Behav Immun, 2021, 93: 368-383.
29. Jang HJ, Lee SM. Influence of surgery preparation time on patient outcomes. J Nurs Manag, 2024, 2024: 6753210.
30. Sandelin A, Kalman S, Gustafsson B. Prerequisites for safe intraoperative nursing care and teamwork-operating theatre nurses' perspectives: a qualitative interview study. J Clin Nurs, 2019, 28(13-14): 2635-2643.

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