Minimally Invasive Esophagectomy: General Problems and Technical Notes

Abstract

Despite its wide acceptance in colorectal surgery, minimally invasive esophagectomy (MIE) in esophageal cancer (EC) is still controversial. The first report of MIE dates back to 1993, when Cuschieri et al. and Collard et al, reported the feasibility of thoracoscopic mobilization of the esophagus and consensual lymphadenectomy in EC patients [1, 2]. The latter work described 12 cases (2 conversions), including seven involving en-bloc resection and the removal of up to 51 nodes [2]. De Paula et al., in 1995, reported the first series of trans-hiatal esophagectomy (THE) using a laparoscopic approach, applied almost exclusively to benign disease [3]. In a series of six patients with EC, Jagot et al., in 1996, were the first to describe a laparoscopic approach for mobilization of the stomach, which was followed by thoracotomy [4]. Since then, many techniques have been developed: hybrid MIE (thoracoscopy/laparotomy; laparoscopy/thoracotomy) or totally MIE (laparoscopy/thoracoscopy). The first case of totally MIE was reported by Luketich et al., in 1998 [5], while Watson et al., in 1999 [6], were the first to describe an Ivor-Lewis subtotal esophagectomy, entirely thoracoscopic and laparoscopic, carried out in two patients and including manual intrathoracic esophagogastric anastomosis.