Totally endoscopic surgery for thoracic esophageal cancer

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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.