• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Laparoscopic and Thoracoscopic Ivor Lewis Esophagectomy

Laparoscopic and Thoracoscopic Ivor Lewis Esophagectomy

Minimally invasive (MIS) Ivor-Lewis Esophagectomy is a technically challenging procedure, but series from expert centers have described its feasibility and safety. The benefit in terms of long-term oncologic outcomes is being investigated. The extent of MIS techniques has ranged from a laparoscopic abdominal component with a thoracotomy, mini-thoracotomy, or thoracoscopic component. This video describes the main steps of a MIS laparoscopic and thoracoscopic Ivor Lewis esophagectomy with upper abdominal and subcarinal lymph nodal dissection and the circular stapled anastomosis with the transoral anvil. We have performed MIS Ivor Lewis Esophagectomy in thirty-seven patients (mean age 67 years; range 45 to 85) with distal esophageal adenocarcinoma (n=29), squamous cell cancer (n=5), or high-grade dysplasia in Barrett’s Esophagus (n=3) between October 2007 and August 2009. The abdominal portion of the operation was completed laparoscopically in 30 patients (81.1%). The thoracic portion was completed using a mini-thoracotomy in 23 patients (62.2%) and thoracoscopic techniques in 14 (37.8%). Proximal and distal margins were negative in all patients. A median of 15 lymph nodes (range 8 to 33) were dissected from each specimen, with a median of 3 (range 0 to 18) histologically positive nodes. No intra-operative technical failures of the anastomosis or deaths occurred. The average hospital stay was 11 days (range 7 to 30). Five patients had strictures (13.5%) and all were successfully treated with either two or three endoscopic dilations. One patient had an anastomotic leak that was successfully treated by re-operation and endoscopic stenting. The operation shown includes laparoscopic hiatal, distal esophageal, and gastroesophageal junction dissection and lymph nodal dissection of the porta-hepatis, left gastric artery, and supra-pancreatic lymph stations. Gastric conduit preparation was performed using multiple firings of a 4.8mm linear stapler. A pyloroplasty was performed and a feeding jejunostomy placed. The thoracic portion was completed using standard thoracoscopic ports and techniques and included mobilization of the esophagus from the esophageal bed, subcarinal lymph node dissection and transection of the most superior aspect of the thoracic esophagus at the level of the thoracic inlet with a 4.8mm linear stapler above the divided azygous vein. The esophagogastric anastomosis was performed using a 25mm anvil passed trans-orally, in a tilted position, and connected to a 90cm long PVC delivery tube through a small opening in the stapled esophageal stump. The anastomosis was completed by joining the anvil to a circular stapler (EEA 25mm with 4.8mm Staples) inserted into the gastric conduit. Then, the gastric conduit opening was closed using an additional firing of a 4.8mm linear stapler.
While long-term oncologic outcomes are still being evaluated, MIS Ivor Lewis Esophagectomy is feasibe and seems safe in high volume centers. It also seems to offer superior visualization of the operative fieldin addition tothe usual benefits of MIS techniques.


Session: Podium Video Presentation

Program Number: V043

2,353

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals