Minimally invasive 3-field esophagectomy with cervical single-port access.

BACKGROUND: Minimally invasive esophagectomy for esophageal cancer include thoracoscopic and laparoscopic esophagectomy with a cervical single-port assist, which is inadequate for both techniques. This is the first reported series applying this technique to treat esophageal cancer patients in literature.

MATERIALS AND METHODS: From March 2007 to April 2011, 12 cases of laparoscopic and thoracoscopic total esophagectomy with a cervical single-port assist were performed. Indications for minimally invasive esophagectomy included esophageal squamous cell carcinoma, diagnosed preoperatively in nonmetastatic tumors and fewer than 4 lymph nodes by endoscopic ultrasonography.

RESULTS: The mean operative time was 440 minutes (range, 347 to 578 min). The mean intensive care stay was 1.6 days (range, 0 to 6 d). The mean hospital stay was 11.8 days (range, 7 to 22 d). Minor complications included atrial fibrillation (n=1), pleural effusion (n=2), and persistent air leaks (n=1), and major complications included cervical anastomotic leak in 1 patient due to technical failure. The 30-day mortality rate was 0.

CONCLUSIONS: Video-assisted thoracoscopic and laparoscopic esophagectomy combined with a cervical single-port assist is a safe and minimally invasive technique for whole esophagus and mediastinal lymph node dissection. This technique allows for the clear visualization of the mediastinum, reducing the risk of surgery-related trauma.