Incisional Approaches for Esophagectomy: Thoracic and Transhiatal Techniques
Transthoracic esophagectomy:
- A left posterolateral thoracotomy is performed.
- The esophagus is dissected from the posterior mediastinum and the esophagus is divided with a stapler.
- The stomach is mobilized and pulled up into the chest and a gastric conduit is created.
- The gastric conduit is then anastomosed to the proximal esophagus.
Transhiatal esophagectomy:
- A laparotomy is performed and the abdomen is explored.
- The abdomen is closed and the patient is placed in the right lateral decubitus position.
- A cervical incision is made and the esophagus is dissected down to the hiatus.
- The esophagus is divided and the stomach is pulled up into the posterior mediastinum and a gastric conduit is created.
- The conduit is then anastomosed to the cervical esophagus.
Hybrid approach:
- Hybrid esophagectomy combines both right thoracotomy and upper midline laparotomy.
- This approach is useful for lesions located in the distal one-third of the esophagus.
Minimally invasive esophagectomy (MIE):
- Minimally invasive esophagectomy refers to various surgical approaches performed through small incisions.
- Common techniques include:
- Thoracoscopic subtotal esophagectomy.
- Hybrid esophagectomy.
- Robotic-assisted esophagectomy.
- Transhiatal esophagectomy with hand-assisted laparoscopy.
- Thoracoscopic transthoracic esophagectomy.
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