Video Presentations

Abstract

The extended lymphadenectomy on esophagectomy for esophageal cancer contributed the improvement of late result but the operative invasion is very high, and the strict management was required postoperatively. Recently endoscopical surgeries are tried as the minimum invasive method in esophagectomy in Japan. Though, there are many problems in the accuracy of thoracoscopic lymphadenectomy and training period for stable technology. Then we have started a clinical trial of mini-thoraco-laparotomy (small incision) for the improvement of patient’s postoperative QOL without loosing any radicality since 1996. In mini-thoraco-laparotomy, thoracotomy was performed with small skin incision about 12–3 cm, and only the 5th intercostal muscle incision was necessary with other muscles preserved. In mini-laparotomy, intra-abdominal approach was made with 12–3 cm small skin incision in upper abdomen. Esophagectomy and lymphadenectomy was performed using super-long forceps and scissors over the gross view with the special light source device. Concerning to operation time, bleeding volume and quantity of lymphadenectomy, these were no difference between in Mini-type and Conventional-type operation. This mini-thoraco-laparotomy could have a certain advantage for early extubation, decrease of plumonal complication, shortening of SURS duration, and prevention of the wound infection. We believe our mini-thoraco-laparotomy could contribute for reduction of invasion of esophagectomy and improves the postoperative QOL with early recovery of postoperative pulmonal function. We will show these techniques of our mini-thoraco-laparotomy by video of middle thoracic advanced cancer case.