Minimally Invasive Oesophagectomy with Two-field Lymphadenectomy

1. Thoracoscopic access and Ports
2. Diaphragm retraction stitch
3. Division of inferior pulmonary ligament up to inferior pulmonary vein
4. Division of mediastinal pleura and development of pericardial plane
5. Division of azygous vein
6. Completion of oesophageal mobilisation
Meso-esophageal vessels are ligated and vagal branches are clipped on the
Oesophagus. Slings are applied
7. Radical nodal resection. Lymph node groups: subcarinal, left and right bronchi, right paratracheal and paracardial
8. Skeletonisation of aortic adventitia and resection of thoracic duct
9. Paravertebral catheter inserted
10. Two chest drains are inserted
11. Laparoscopic access and Ports
12. Division of gastro-hepatic ligament and mobilisation of right crus
13. Skeletonisation of left gastric artery pedicle and coeliac axis with extended lymphadenectomy, removing coeliac, common hepatic and splenic artery origin nodes
14. Ligation of left gastric artery
15. Mobilisation of greater curve with careful preservation of gastro-epiploic arcade
16. Division of short gastric vessels and mobilisation of left crus
17. Division of gastro-epiploic ligament and mobilisation or retro-pyloric region
18. Kocherisation of duodenum
19. Division of gastric artery arcade and preservation of right gastric artery
20. Division of stomach to create lower border of resection and formation of gastric conduit
21. Completion of mobilisation of gastro-oesophageal junction with division of phreno-esophageal junction and retrieval of lower sling
22. Division of right crus
23. Suturing of conduit to lower specimen
24. Delivery of specimen into neck via left cervical incision. The proximal oesophagus is divided with completion of oncological resection
25. Open, end-to-side anastomosis
26. Return of anastomosis into neck, and removal of slack from conduit
27. Suturing of conduit to right crus
28. Wounds after six weeks
29. Results (MIO 70 BJS), mortality rate, op time (med/range), LN yield (m/r)
30. Results 2, Survival and DFS survival graphs and text for % @ 2yrs
31. Acknowledgements

Direction: Veeramootoo D
Narration: Taylor C
Editing: Cresswell R
Operating Team: Krishnadas R, Berrisford RG, Wajed SA

Session: Podium Video Presentation

Program Number: V043

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