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Minimally Invasive Ivor Lewis Esophagectomy Without Patient Repositioning

  • Benjamin M. Motz
  • Patrick D. Lorimer
  • Danielle Boselli
  • James T. Symanowski
  • Mark K. Reames
  • Joshua S. Hill
  • Jonathan C. SaloEmail author
How I do it
  • 63 Downloads

Abstract

Introduction

The standard technique for Ivor Lewis minimally invasive esophagectomy involves a two-stage approach necessitating repositioning mid-procedure.

Technique

We describe our technique for a one-stage hand–assisted minimally invasive esophagectomy that allows sequential access to the chest and abdomen within the same surgical field, eliminating the need for repositioning. The patient is positioned in a “corkscrew” configuration with the abdomen supine and the chest rotated to the left to allow access to the right chest. The abdomen and chest are prepped into a single operative field. This technique allows sequential access to the abdomen for gastric mobilization, chest for division of the esophagus, abdomen for construction of the gastric conduit, and chest for intrathoracic anastomosis.

Conclusion

This approach enables extracorporeal construction of the conduit, which helps ensure a clear distal margin on the specimen and facilitates conduit length by placing the stomach on stretch during stapling.

Keywords

Esophageal neoplasms Esophagectomy Laparoscopic surgery Thoracoscopic surgery Minimally invasive surgical procedures Anastomotic leak 

Notes

Acknowledgments

The authors acknowledge Jill J. Jurgensen for editing assistance and Brian C. Brockway for providing illustrations.

Authors’ Contributions

Study conception and design: J.C.S., B.M.M.

Acquisition of data: J.C.S., M.K.R.

Analysis and interpretation of data: J.C.S., B.M.M., D.B., J.T.S.

Drafting of manuscript: B.M.M., P.D.L., J.C.S., D.B.

Critical revision: B.M.M., P.D.L., J.C.S., J.S.H.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of Surgery, Division of Surgical Oncology, Carolinas Medical CenterLevine Cancer InstituteCharlotteUSA
  2. 2.Department of Biostatistics and Informatics, Levine Cancer InstituteAtrium HealthCharlotteUSA
  3. 3.Carolinas Medical CenterSanger Heart and Vascular InstituteCharlotteUSA

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