An Experience of Thoracoscopy-assisted Esophagectomy for Esophageal Cancer

We have devised a technique of thoracoscopy-assisted esophagectomy with minithoracotomy, which is safe and able to reduce surgical stress.We report here the clinical use of this method.The patient was a 76-year-old man who had advanced esophageal cancer of type 3, 8cm in length at Im.He also had severe obstructive pulmonary disorder.The spirometric examination showed that his FEV 1.0% was 39.3%, In the operation, the patient was placed in the supine position, and laparotomy was performed.Following reconstruction with the stomach through the retro-sternal route, a right mini-thoracotomy, which was approximately 10cm in length, was made through the 5th intercostal space with the patient in a left lateral position. Two 12mm trocars were placed in the 4th and 6th intercostal spaces.The thoracic esophagus could be removed safely under the thoracosopic guidance.His respiratory state in the postoperative period was stable, and there was no deterioration of postoperative blood gas findings in comparison with preoperative ones.We consider that it may be possible to extend the applications of this method to patients with preoperative pulmonary complications, the aged, or those with superficial cancer because of the magnified operative view and better manipulation permitted by thoracoscopic observation.