Generation of a surgical field at the mid-lower mediastinum for thoracoscopic esophagectomy in the left lateral decubitus position: Case series

Abstract

IntroductionThe generation of a good surgical field at the mid-lower mediastinum during thoracoscopic esophagectomy in the left lateral decubitus position is often complicated. Here, we developed a simple and useful technique for surgical field generation. MethodsAmong 225 patients who underwent esophageal resection from April 2015 to December 2019, 154 underwent thoracoscopic esophagectomy using our following-described method.The patients are placed in the left lateral decubitus position similarly to open thoracotomy, and a 12-mm port is inserted at the midaxillary line in the third, fifth, and seventh intercostal spaces and anterior to the inferior angle of the scapula in the ninth (scope port). A 5-mm port is inserted at the inferior angle of the scapular line in the sixth and eighth. The mid-lower mediastinal procedure is performed first, with the operator and camera holder positioned at the ventral side and the assistant at the dorsal side of the patient. A camera displays the surgical field on the monitor as in the prone position. Thoraco-cotton with a stainless-steel shaft is inserted through the third port to compress the upper and lower lobes of right lung and simultaneously make counter traction to the ventral side of the esophagus. ResultWe hardly encounter any difficulty with surgical field generation in the middle-lower mediastinum without one patient having abnormal divergence of right superior lobar branch, or any patients with intraoperative complications. ConclusionOur newly described method is very simple and easily adapted for thoracoscopic esophagectomy in the left decubitus position.