This document describes the technique for a thoracolaparoscopic esophagectomy. It summarizes the steps including:
1) Initial thoracoscopic dissection of the esophagus in the chest, with ligation of vessels and azygos vein.
2) Laparoscopic mobilization of the stomach and dissection of the esophagus in the abdomen.
3) Creation of a gastric conduit and cervical anastomosis through a neck incision.
The minimally invasive approach allows for better exposure during dissection, less pulmonary morbidity, and shorter hospital stays compared to open surgery. Evidence is accumulating that it may provide benefits over open esophagectomy.
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Minimally Invasive Esophagectomy Procedure
1. Thoroacolaparoscopic
Esophagectomy
Dr. K. Sendhil Kumar
MS, FICS, FACS(USA), DNB(SURG GASTRO)
Dr. Piyush Patwa
MBBS. DNB, FMAS, FIAGES, FAIS
Gateway Clinics, Coimbatore
MINIMALLY INVASIVE ESOPHAGECTOMY
2. INITIAL EXPERIENCE
Early on Minimally Invasive Esophagectomy Lacked a Consistent
Minimally Invasive Approach
• Right VATS, laparotomy and neck incision
• Laparotomy for gastric mobilization, thoracoscopic esophagectomy
and intrathoracic anastomosis
• Laparoscopic gastric mobilization, thoracotomy with intrathoracic
anastomosis
• Thoracoscopic esophagectomy, laparoscopic hand-assisted
• Totally laparoscopic mobilization, esophagectomy with neck
anastomosis (Transhiatal)
No advantages noted at that time, but clearly no consistent approach
had emerged
36. GOING INTO THE ABDOMEN
BY LAPAROSCOPY
• SEMILITHOTOMY POSITION
• PNEUMOPERITONEUM
• 5 PORTS
• 12-14 mm Hg PRESSURE
• ULTRASONIC ENERGY AND VESSEL SEALING
SYSTEM
• STEEP REVERSE TRENDELENBURG’S TILT
43. AFTER DIVIDING THE GASTROHEPATIC LIGAMENT
LEFT LOBE
LIVER
CAUDATE
LOBE
COMMON
HAPATIC ARTERY
LEFT GASTRIC
VEIN
RT
CRUS
APPRECIATE THE ANATOMY BEFORE DISSECTING
64. Summary
• Minimally invasive techniques can be used to
perform most Esophagectomy procedures
• Evidence of patient benefit is starting to accumulate
in both retrospective single centre studies &
prospective, multi-centre trials.
• Less chance of pulmonary morbidity – Shorter
hospitalization
65. Please watch the video with the link given below
• https://www.youtube.com/watch?v=06deeIH
aAN8
66. Dr. K. Sendhil Kumar
Dr. Piyush Patwa
Gateway Clinics, Coimbatore