Totally endoscopic surgery for thoracic esophageal cancer

1)导言从微创手术的角度来看，1993年，美国人开始了胸腔镜式食道切除术。为了追求管理信息系统的完备性，我们努力开发出一种胸腔镜下食道切除和腹腔镜胃管重建术相结合的手术方法。1997年5月，第一例手术成功。该程序在技术上似乎是可行的，因此我们将在这段视频中介绍它。2)手术方式与结果：手术先重建，后切除食道。“胃管腹腔镜重建术”：切开取石位。5个套管针在气腹下锚定。在剥离食道裂孔后，用机械吻合器在腹侧食道水平切除食道。采用手助腹腔镜手术(HALS)分离胃短血管。外科医生的左手通过7厘米开腹切开后插入。保留胃网膜右动脉的方法是在外科医生的左掌中保持其搏动，以保密的方式进行。胃充分活动后，在直视下形成胃管。经同一创面行茎后重建。颈部切开创面实现颈段食道与胃的吻合术。“胸腔镜式食道切除术”：左侧卧位单肺通气法。胸段食道剥离加纵隔淋巴结清扫术仅用胸腔镜钳插入右胸壁7个套管针。3)结论该管理信息系统在技术上是可行的，手术安全可靠。

1) Introduction From the standpoint of minimally invasive surgery (MIS), aturhors started thoracoscopic esophagectomy in 1993. To pursue completeness of MIS,we endeavored to develop a combined procedure of thoracoscopic resection of the esophagus and laparoscopic reconstruction using gastric tube. In May 1997, the first case was successfully operated on. That procedures seems to be technically feasible and therefore we will introduce it in this video. 2) Surgical procedures and results Surgery was performed by reconstruction first, then proceeded to esophageal resection. "Laparoscopic reconstruction using gastric tube" : Lithotomy position. Five trocars were anchored under pneumoperitoneum. After dissecting esophageal hiatus, esophagus was resected at the level of abdominal esophgus using mechanical stapler. To divide short gastric vessels, hand-assisted laparoscopic surgery (HALS) was employed. Surgeon's left hand was inserted through 7-cm open laparotomy would. Preservation of right gastroepiploic artery was confidentially carried out by keeping its pulsation in surgeon's left palm. After full mobilization of the stomach, formation of the gastric tube was made under direct vision. Retrostemal reconstruction route was made through the same wound. Anastomosis between cervical esophagus and pulled-up stomach was achieved through open cervical wound. "Thoracoscopic esophagectomy" : Left lateral position and single lung ventilation. Dissection of thoracic esophagus with mediastinal lymph node dissection was carried out only by thoracoscopic forceps inserted through seven trocars on right chest wall. 3) Conclusion This MIS seems technically feasible and safe surgery for patients.