Transcervical Videoscopic Esophageal Dissection in Minimally Invasive Esophagectomy

Introduction: Currently, minimally invasive esophagectomy (MIE) is being performed using Video-Assisted Thoracoscopic Surgery (VATS) for mediastinal esophageal dissection. The VATS approach is still associated with pulmonary and cardiovascular morbidity, as well as incisional pain. This study investigates the feasibility of MIE using a single-incision transcervical videoscopic esophageal dissection (TVED). A simultaneous laparoscopic and transcervical videoscopic approach would allow MIE without the need for patient repositioning or single lung ventilation.

Methods: Technical steps of the procedure include a standard cervical incision large enough to accommodate a modified hand-assisted access device. Cervical esophageal dissection was done in standard fashion. The modified access device was placed, and pneumomediastinum was established with laparoscopic trocars placed through the access port. The tracheoesophageal plane was developed above and below the thoracic inlet. Vagal nerves were identified, dissected, and divided distal to the recurrent branches. Standard minimally invasive laparoscopic techniques were used for the esophagogastric dissection routinely performed in MIE. Following specimen extraction, the animals were euthanized as per protocol.

Results: A full circumferential dissection of the mediastinal esophagus was successfully accomplished in both animals using a single-incision TVED for MIE.

Conclusions: Our research describes a novel approach for mediastinal dissection of the esophagus using a TVED approach that may avoid the potential morbidity of VATS while providing better visualization of the upper mediastinal esophagus when compared to the transabdominal, transhiatal approach.


Session: Podium Video Presentation

Program Number: V005

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