Minimally invasive esophagectomy (MIE) may involve video-assisted thoracoscopic surgery (VATS) for mediastinal esophageal dissection. Usually, VATS requires single-lung ventilation and has associated cardiopulmonary morbidity [1–3]. Alternatively, transhiatal dissection can be performed, although its complications include vocal cord palsy , cardiac arrythmias , and increased bleeding [5, 6], the latter associated with mortality after esophagectomy . Therefore, the feasibility of MIE using transcervical videoscopic esophageal dissection (TVED) in swine was investigated. A simultaneous laparoscopic and TVED approach may decrease operative time and blood loss while improving visualization and avoiding single-lung ventilation.
Two pigs (Sus domesticus) underwent two similar procedures. The methods were approved by the authors’ Institutional Animal Care and Use Committee (no. A24209) under United States Department of Agriculture guidelines. Steps included a cervical incision to accommodate a modified hand-assist access device. The cervical esophagus was dissected. Trocars were placed through the modified access device, and pneumomediastinum was established. The tracheoesophageal plane was dissected into the thorax and beyond the mid esophagus, on which the pleura of the separate mediastinal compartment inserts itself. Vagal nerves were identified and divided distal to recurrent branches. Standard laparoscopic techniques were used for esophagogastric dissection. After specimen extraction, the animals were euthanized.
A full circumferential dissection of the mediastinal esophagus was successfully accomplished in two animals using a single-incision TVED for MIE.
A novel technique for mediastinal esophageal dissection using a TVED approach performed with instruments designed for single-port surgery is described. Fortunately, the human lacks the swine’s separate mediastinal compartment, and this unique difference should facilitate the human version of this dissection. This approach may avoid the potential morbidity of VATS while providing better visualization and facilitating dissection of the upper mediastinal esophagus compared with either the transhiatal approach or the previously attempted rigid mediastinoscopic approaches [7–9].
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Collard JM, Lengele B, Otte JB, Kestens PJ (1993) En bloc and standard esophagectomies by thoracoscopy. Ann Thorac Surg 56:675–679
Law S, Wong KH, Kwok KF, Chu KM, Wong J (2004) Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg 240:791–800
Smithers BM, Gotley DC, McEwan D, Martin I, Bessell J, Doyle L (2001) Thoracoscopic mobilization of the esophagus: a 6-year experience. Surg Endosc 15:176–182
Decker G, Coosemans W, De Leyn P, Decaluwe H, Nafteux P, Van Raemdonck D, Lerut T (2009) Minimally invasive esophagectomy for cancer. Eur J Cardiothorac Surg 35:13–20, discussion 20–21
Nguyen NT, Follette DM, Wolfe BM, Schneider PD, Roberts P, Goodnight JE Jr (2000) Comparison of minimally invasive esophagectomy with transthoracic and transhiatal esophagectomy. Arch Surg 135:920–925
Katariya K, Harvey JC, Pina E, Beattie EJ (1994) Complications of transhiatal esophagectomy. J Surg Oncol 57:157–163
Ikeda Y, Niimi M, Kan S, Takami H, Kodaira S (2002) Thoracoscopic esophagectomy combined with mediastinoscopy via the neck. Ann Thorac Surg 73:1329–1331
Buess G, Kaiser J, Manncke K, Walter DH, Bessell JR, Becker HD (1997) Endoscopic microsurgical dissection of the esophagus (EMDE). Int Surg 82:109–112
Bumm R, Feussner H, Bartels H, Stein H, Dittler HJ, Hofler H, Siewert JR (1997) Radical transhiatal esophagectomy with two-field lymphadenectomy and endodissection for distal esophageal adenocarcinoma. World J Surg 21:822–831
We acknowledge Applied Medical and Novare Surgical for their material support of this research. This study is a result of pilot data obtained from a grant given by the Society of American Gastrointestinal and Endoscopic Surgeons.
Michael Parker, Jason M. Pfluke, Kyle K. Shaddix, Horacio J. Asbun, C. Daniel Smith, and Steven P. Bowers have no conflicts of interest or financial ties to disclose.
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Parker, M., Pfluke, J.M., Shaddix, K.K. et al. Transcervical videoscopic esophageal dissection in minimally invasive esophagectomy. Surg Endosc 25, 941–942 (2011) doi:10.1007/s00464-010-1253-1