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Totally thoracoscopic and laparoscopic Ivor Lewis esophagectomy in obese patients

Epublication WebSurg.com, Oct 2011;11(10). URL: http://websurg.com/doi/vd01en3414

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Totally thoracoscopic and laparoscopic Ivor Lewis esophagectomy using a circular stapler or manual anastomosis has recently been described by a few authors. We performed this challenging technique with a completely thoracoscopic hand-sewn esophagogastric anastomosis in two obese patients in prone position (one female and one male), affected by an adenocarcinoma of the lower third of the esophagus without lymph node invasion (pT2 N0) and with a BMI of 35 and 32 respectively. The first female patient is the subject of this video. Thoracoscopy lasted 150 minutes (anastomosis was 50 minutes long), laparoscopy lasted 130 minutes, and second laparoscopy lasted 20 minutes. Blood loss was estimated at 150 mL. The gastrografin swallows (on postoperative day 7 in both patients) showed absence of stenosis and leak. The patients had an uneventful postoperative course and were discharged on postoperative day 12 and 10, respectively. Thoracoscopy in prone position allows the surgeon to perform a thoracoscopic esophagogastric anastomosis completely hand-sewn without selective lung exclusion, and using only three trocars. In obese patients, although the technique is foremost challenging, the advantages of minimally invasive surgery are undeniable —better intraoperative respiratory function (avoiding selective lung exclusion) and less complicated postoperative course.