A novel technique of mediastinoscopy-assisted esophagectomy with a flexible laparoscope and endoscopic overtube.

In mediastinoscopy-assisted esophagectomy, mobilizing the thoracic esophagus with visualization through the mediastinoscope is often difficult. We report a novel technique of transmediastinal esophagectomy with a flexible laparoscope and endoscopic overtube for a patient with early thoracic esophageal cancer. An endoscopic overtube was carefully inserted through the hiatus into the posterior mediastinum, and a laparoscope was inserted into the overtube. Surgical devices were inserted into the mediastinum through another overtube through the hiatus, and the middle and lower thoracic esophagus were mobilized as much as possible. The upper thoracic esophagus and upper mediastinal lymph nodes were mobilized through the neck, preserving the recurrent nerve, with visualization through the laparoscope through the overtube inserted into the upper mediastinum from the cervical space. The operation time was 285 minutes and blood loss was 200 g. There were no postoperative complications. Mediastinoscopy-assisted esophagectomy with a flexible laparoscope and endoscopic overtube is a feasible and useful technique.