Esophageal Cancer

Thoracoscopic Esophagectomy

We have been successfully performing minimally invasive esophagectomy through a 10-cm thoracotomy and five trocar ports. Esophagectomy can be performed safely and efficiently via thoracoscopy.

Esophageal Mobilization

After intubated with a double lumen endotracheal tube for single lung ventilation, the patient is positioned in the left lateral decubitus (right side up). Five thoracoscopic ports are introduced. A small incision is made at the sixth intercostal space posterior to the posterior axillary line for placement of 10 mm camera port. Two additional ports are placed, one at the eighth intercostal space, post-axillary line, another at the sixth intercostal space on midaxillary line. These two ports are for main manipulation. Other two additional ports are placed for retraction during dissection. 

The major mission of the thoracic procedure is to dissect or mobilize the esophagus in chest cavity. The mediastinal pleura overlying the esophagus is divided and the entire thoracic esophagus is exposed. A penrose drain is placed around the mid-esophagus to facilitate traction and exposure. Circumferential mobilization of the esophagus with all surrounding lymph nodes and peri-esophageal tissue and fat is performed from the diaphragmatic reflection up to the thoracic inlet. When lymphatics and aorto-esophageal vessels met, endoclips are used liberally on the posteriorly to minimize bleeding and chylothorax complications. 

Dissecting the lymph node and get it out from the thoracic cavity. We often use a sac to put it in to prevent cancer cell from spreading.

The azygos vein is divided using the Endo-GIA vascular stapler or after ligature with thread. 

A single 26 F chest tube is inserted through the camera port and the other port sites are closed with absorbable sutures.

Results

We have performed Thoracoscopic Esophagectomy in over 100 patients since 1997.Comparing the number of lymph nodes resected thoracoscopicaly with which in traditional thoracotomy, we find there is no obvious difference. The completion of the thoracic esophageal mobilization and lymph node dissection was satisfactory.