Combined laparoscopic and thoracoscopic approach to esophagectomy

Esophagectomy for benign or malignant disease is a complex and challenging surgical procedure that can be associated with significant morbidity and mortality. In an attempt to decrease morbidity, surgeons are beginning to apply minimally invasive techniques to esophagectomy. A number of authors have reported on laparoscopicor thoracoscopic-assisted esophagectomy. Most of these reports included a standard laparotomy with the addition of thoracoscopic esophageal mobilization and lymph node dissection. To date, only 2 reports of total laparoscopic esophagectomy have been published. DePaula and colleagues were the first group to report a series of 48 patients undergoing laparoscopic transhiatal esophagectomy for benign and malignant diseases. Swanstrom and Hansen also reported 9 cases of laparoscopic transhiatal esophagectomy. We also reported this approach but found that the completion of the thoracic esophageal mobilization and lymph node dissection was unsatisfactory from a totally laparoscopic approach and found the addition of thoracoscopy very helpful. In this article, we describe our combined thoracoscopic and laparoscopic approach to esophagectomy.