The three-hole esophagectomy. The Brigham and Women's Hospital approach (modified McKeown technique).

The three-incisional technique described above allows the surgeon to do a safe resection that includes a complete lymphadenectomy and a cervical esophagogastric anastomosis. The advantages of a neck anastomosis have been detailed elsewhere and briefly include a lower incidence of reflux symptoms, a more extensive proximal resection margin, position outside prior radiation ports, and easier management of an anastomotic leak should it occur. By performing this in two phases, the operation can be performed efficaciously. The subtle nuances detailed, such as the use of Penrose drains and the arthroscopic camera bag to deliver the specimen, help to avoid some of the potential complications generally associated with an esophagectomy.