Surgeon at Work: Hand-Assisted Laparoscopic Construction of Gastric Conduit for Thoracic Esophageal Cancer

A method for hand-assisted laparoscopic construction of gastric conduit for thoracic esophageal cancer was developed. Since this endoscopic surgical procedure is less invasive than open surgery, it contributes to improvement of post-operative respiratory functions and reduces respiratory complications. What distinguishes our surgical procedure is that unlike methods described in previous reports, it begins with treatment of the left gastroepiploic vessels at the height of the inferior edge of the spleen, followed by dissection from the esophageal hiatus to the lesser curvature and then dissection and excision of left gastric arteries and veins. Finally, the exposed esophagus and stomach are drawn outside the body and the right gastroepiploic blood vessels are preserved, followed by dissection of the greater omentum. This approach to gastric conduit construction was undertaken in 6 patients and the mean operating time was 123 minutes. Although in the first 3 of these patients the operating time was 150 minutes or more, the time required shortened to around 90 minutes for each of the last 3 cases, as the procedure was mastered. In each case, the volume of intraoperative hemorrhage did not exceed 50 ml.