Esophagectomy via laparoscopy and transmediastinal endodissection.

An original technique for minimally invasive transmediastinal esophagectomy is described. A combined laparoscopic and video-mediastinoscopic approach was attempted in a series of patients with high-grade dysplasia or carcinoma of the esophagus. Laparoscopy allowed mobilization of the stomach and dissection of the distal esophagus at least up to the level of the inferior pulmonary veins. Through a left cervicotomy, endodissection of the upper thoracic esophagus was accomplished with an operating video-mediastinoscope. After complete upward and downward mobilization from the mediastinal bed, the specimen was retrieved through the cervical incision and the stomach was guided laparoscopically into the posterior mediastinum. Compared to the laparoscopic total esophagectomy, this approach provides a more controlled and safer dissection of the upper mediastinum.