Hand-assisted laparoscopic surgery for the abdominal phase in endoscopic esophagectomy for esophageal cancer: an alteration on the site of minilaparotomy.

The authors present an alteration at the site of a minilaparotomy in the abdominal phase of endoscopic esophagectomy and reconstruction by means of hand-assisted laparoscopic surgery. In the first case, a minilaparotomy was performed in the lower right side of the abdomen during laparoscopic construction of a gastric tube using hand-assisted laparoscopic surgery. However, this technique was not always feasible because an elaborate technique was necessary, even with the use of the surgeon's hand, which was inserted in the abdomen through the mini-incision. After the second case, the authors performed a minilaparotomy slightly above the stomach. The upper abdominal incision allowed easier and safer management of the gastric tube. This technique was also helpful in the Kocher maneuver and in the construction of the retrosternal route. The site of the minilaparotomy in the upper abdomen reduced the stress of this procedure, and, therefore, became the standard procedure for select patients at the First Department of Surgery, Tokyo Medical and Dental University.