Transhiatal blunt esophagectomy.

The operation of transhiatal esophagectomy has been revived in recent years, and several series have reported upon some of the advantages of this procedure over esophagectomy by way of a thoracotomy. Because part of the technique involves a "blind" dissection, it is important that the surgeon is completely familiar with the anatomic relations of the esophagus. A careful anatomic review of these relations was undertaken and important anatomic landmarks have been highlighted with the aid of anatomic dissection. Areas of anatomic fixation are found particularly at the tracheal bifurcation, the dome of the right pleura and the arch of the aorta. The right pleura also crosses the midline between the levels corresponding to the fifth and tenth thoracic vertebrae, and at the eighth thoracic vertebra, there is close proximity of pleurae. A better appreciation of these anatomic features will help the surgeon to decrease the morbidity of the transhiatal esophagectomy.