Totally endoscopic surgery for thoracic esophageal cancer

1)从微创手术（MIS）的角度来看，1993年，医生开始进行胸腔镜食管切除术。为了追求微创手术的完整性，我们建议采用胸腔镜食管切除和腹腔镜胃管重建的联合手术。1997年5月，第一个病例成功地进行了手术。该程序在技术上似乎是可行的，因此我们将在这段录像中介绍它。2)手术方法和结果手术首先通过重建进行，然后进行食管切除。"腹腔镜胃管重建术"：取石位。在气腹下锚定了5个穿刺器。在解剖食管裂孔后，使用机械吻合器在腹外肌水平切除食管。为了分离胃短血管，采用手辅助腹腔镜手术（HALS）。外科医生的左手通过7厘米的开腹手术插入。保留胃网膜右动脉在术者左手掌心搏动。胃完全游离后，在直视下形成胃管。胸骨后重建路径通过相同的伤口。经颈部开放性切口，将颈部食管与上提胃吻合。"胸腔镜食管切除术"：左侧卧位，单肺通气。仅通过胸腔镜钳插入右胸壁的7个套管针进行胸段食管剥离和纵隔淋巴结清扫。3)结论该微创手术技术可行，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.