Video-Assisted Esophageal Mobilization—Video 23

Published on 13/02/2015 by admin

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CHAPTER 23 Video-Assisted Esophageal Mobilization—Video 23

Robert J. McKenna, Jr.

Introduction

Mobilization of the esophagus by video-assisted thoracic surgery (VATS) offers the advantage of a complete cancer operation performed with minimally invasive surgery. Although most VATS procedures are performed with the patient in the lateral decubitus position, the prone position offers several advantages for surgery on structures in the posterior mediastinum. Because gravity causes the lung to fall out of the way, lung retraction required in the lateral position is not needed when the patient is prone. Only three small incisions are needed to perform the procedure. The planes of dissection are the azygous vein, aorta, pericardium, vertebral bodies, and the trachea, allowing a thorough cancer operation with wide dissection and a complete nodal dissection to be performed.

Approach to Video-Assisted Esophageal Mobilization

Order of Operative Steps

The order of the steps of the operation are as follows: dissect on pericardium, dissect along azygous vein and aorta, remove subcarinal nodes, clip the thoracic duct, transect the azygous vein, and dissect the esophagus at the apex of the chest.

Key Points

♦ Perform esophagogastroduodenoscopy with the patient in the supine position on the gurney, and then place the patient prone on the operating table.
♦ Dissect inferiorly to superiorly in the chest.
♦ Dissect along the pericardium first, because if dissection along the azygous is done first, the esophagus falls in the way when dissecting the pericardial plane after the posterior dissection.

image Video-Assisted Esophageal Mobilization (Video 23)

Step 1. Esophagoscopy and Positioning

♦ With the patient asleep and in the supine position on the gurney, perform esophagogastroduodenoscopy.
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