Thoracoscopic subtotal oesophagectomy.

A technique for endoscopic-assisted oesophagectomy is described using either a lateral or prone position for the oesophageal dissection. In a consecutive series of 34 patients, two were found to have hepatic deposits at preliminary laparoscopy, and four were inoperable at thoracoscopic staging. A further two had fibrous obliteration of the pleural cavity. Of the 26 procedures, 20 were performed in the lateral position and six in the prone position. There was one conversion to open thoracotomy due to massive aortic bleeding. There were no deaths. Postoperative complications included pneumonia (n = 3), recurrent laryngeal nerve palsy (n = 2) and one anastomotic leak. The median postoperative stay was 12 days (range 9-30 days). It is suggested that the prone position has technical advantages and reduces the postoperative respiratory complications.