VS03.03: MINIMAL INVASIVE ESOPHAGECTOMY BY VIDEO ASSIST TRANSHIATAL-TRANSCERVICAL APPROACHE

Abstract

Abstract Description Trans hiatal esophagectomy avoid trans-thoracic surgery and reduce postoperative complications relate to thoracic surgery. However, the limitation of Trans hiatal esophagectomy is blunt dissection might result to some sever complications. We establish a video assistant transhiatal-transcervical approach (VATT) which can let the entire esophagus be dissected under video scope. Patient was in supine position, intubated with a single-lumen endotracheal tube. Abdomen part: Gastric was dissociated under laparoscope. Distal and middle part of the esophagus was dissected with the laparoscope also. The lower mediastinal lymph nodes including gas (figure 4), it let the dissection of upper esophagus and lymph nodes become easy under video scope. Cervical part: Two incisions in neck were made, a 3–4cm incision in left side, another 1–2cm incision in right side. From the left side incision, blunt dissection of the cervical esophagus was carried down to the level below thoracic inlet. The esophagus was cut off at the level of thoracic inlet. A traction tube was inserted into the distal esophagus. The end of traction tube was fixed to the cutting edge of distal esophagus; the top of the traction tube was taken out from a small incision made in lesser curvature of stomach. Pulling the traction tube slightly, the edge of esophagus was invaginated in the channel of esophagus; a space in the upper mediastinum was established. A trocar was placed in right side cervical incision. In the left side cervical incision, a device made by our-self was placed in. This device is consisted with a glove, a wound retractor protective sleeve and three trocars (figure 3). With this device, the mediastinum space can be gas, this let the dissection of upper esophagus and lymph nodes become easy under video scope. this technique was invented by ourself, so it is unique for the congress. This surgical technique was effective and safe, which can be applied as one of supplementary operation methods to traditional minimally invasive esophagectomy. Disclosure All authors have declared no conflicts of interest.