Establishment of thoraco- and laparoscopic esophagactomy as a minimally invasive surgery

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We endeavored to develop a minimally invasive surgery for esophageal cancer using thoraco- and laparoscopic approach.The first clinical case received this surgical procedure in June 2, 1997. Ten years have passed after that surgery, and now he is doing well with no recurrence of esophageal cancer. Our surgical procedure is a combination of HALS (hand-assisted laparoscopic surgery) procedure and VATS (video-assisted thoracoscopic surgery). In the initial phase of the surgery, cervical area and abdominal areas are firstly approached. Using HALS technique, whole stomach is fully mobilized and then gastric tube is designed. Transphrenic dissection of lower esophagus is done by laparoscopic approach. Bilateral cervical dissection is performed from neck surgical wound. In the cervical operative field, bilateral recurrent laryngeal nerves are taped by vascular tape which is utilized for safe and effective management of lymph node dissection along the recurrent laryngeal nerves at the thoracoscopic phase. We call this technique as "ropeway technique".So far, 120 cases received this procedure as a surgery for esophageal cancer. One month operative death was one (0.8%). In that case the major cause of death was renal failure with no major surgical trouble. Crude overall five year survival rate including other causes of death was 56%. Mean operating time was less than 6 hours.We believe that the techniques of thoraco- and laparoscopic surgery for the esophagus have been established. In the future further improvement of the surgical techniques is expected as a more minimally invasive treatment.