Non-fasting, tubeless, minimally invasive esophagectomy: A simplified procedure.

Recent advances in minimally invasive techniques have made thoracoscopic and laparoscopic esophagectomy a real alternative to open 3-field esophagectomy, with better results in terms of reduction of morbidity and mortality.  In this video tutorial we demonstrate our technique of minimally invasive esophagectomy with cervical anastomosis, which is summarized briefly as follows: The patient is placed in a left lateral decubitus position. Four ports are used for thoracoscopic mobilization of the thoracic esophagus and for mediastinal lymph node dissection. No chest drain is inserted after the thoracic phase of the operation. Once the thoracic procedure is complete, the patient is turned to a supine position and the head is turned to the right. A 3-4 cm left cervical incision is made and, after blunt dissection, the cervical esophagus is transected. Five ports are used for laparoscopic gastric mobilization, carefully preserving the right gastroepiploic pedicle.  A linear cutting stapler is used to make a 4-cm gastric tube. Finally, a 2-layer cervical anastomosis is constructed between the distal esophagus and the gastric tube.