Minimally Invasive Esophagectomy
In a minimally invasive esophagectomy, the esophageal tumor is removed through small abdominal incisions and small incisions in the right chest (thoracoscopy). The esophagogastric anastomosis is located in the upper chest as in the "open" Ivor Lewis technique.
Laparoscopic incisions for Minimally Invasive Ivor Lewis Esophagectomy
Division of the Gastro-Colic Ligament during laparoscopic mobilization of the stomach
Esophagectomy at most medical centers is performed exclusively via open incisions in both the chest and the abdomen, meaning that the ribs are spread apart and the abdominal wall is widely opened. This results in more discomfort and possibly prolonged recovery times.
At Stanford, however, totally laparoscopic and thoracoscopic esophagectomy allows thoracic surgeons in some cases to perform a standard "Ivor Lewis"-type esophagectomy through five small abdominal incisions and 3-4 right VATS (thoracoscopy) incisions.
The abdominal cavity and the right thoracic cavity are directly viewed with a tiny, 10 mm, video camera that is placed through one of the small incisions. Minimally invasive esophagectomy is a particularly good option (along with transhiatal esophagectomy, which also avoids thoracotomy), for patients with earlier stage tumors, as well as for elderly patients and patients with moderate lung disease who have a somewhat higher risk for complications.
Laparoscopic preparation of the gastric conduit (Neo-esophagus)
The right VATS incisions that are used to mobilize the esophagus
Thoracoscopic (VATS) mobilization of the esophagus
Esophago-Gastric anastomosis with a circular stapler