The procedure of single-port inflatable mediastinoscopy and laparoscopic surgery for radical esophagectomy

It has been described as a new non-transthoracic esophagectomy that the single-port inflatable mediastinoscopy and laparoscopic surgery is safe and effective for the radical esophagectomy of esophageal cancer. This report describes the whole procedure in detail. The patient lies in the supine position with the legs apart. The procedure is performed under general anesthesia with a single lumen endotracheal tube. For upper mediastinal operation, a lateral incision of the clavicle was made about 3 cm; for laparoscopic operation, the incisions of 5 ports for the laparoscopic operation. CO(2) insufflation is performed into the mediastinum with 10 mmHg to make artificial mediastinal emphysema. The Maryland forceps is used to perform separation before dissection. In the non-transthoracic esophagectomy, it is essential to expose the recurrent laryngeal nerve and the azygos vein. The lymph nodes around the esophagus were removed in en bloc. Maintaining double lung ventilation during surgery can significantly reduce carbon dioxide accumulation, especially for those with reduced lung function or severe pleural adhesion. Furthermore, it saves much time that upper mediastinal operation and laparoscopic operation are undergone simultaneously. It is a perfect surgical technique that is worth to promote.