Mayo stand and back table instruments for Laparoscopic Transhiatal Esophagectomy surgery setup
Clamping & Occluding
Cutting & Dissecting
Grasping & Holding
Retracting & Exposing
Suturing & Stapling
What to expect during Laparoscopic Transhiatal Esophagectomy
In recent times, the most common way to perform an esophagectomy is to perform what is called a Minimally Invasive Esophagectomy (MIE), or a Laparoscopic Transhiatal Esophagectomy. The old way of doing it was performing a three incision method (a cervical, thoracic, and abdominal incision.) This lowers complication rates and morbidity. Esophagectomies are commonly performed on patients with esophageal cancer and strictures.
Positioning: Supine in reverse Trendelenburg with the entire neck, chest, and abdomen prepped
Equipment: Camera and light box, suction, CO2, surgeons preference staplers
Steps: 5 ports will be used. The first port inserted will be the 12mm port above the bellybutton (umbilicus). The insufflation tubing will be attached, and a 30 degree laparoscope will be inserted. Two 5mm ports will be placed. One of these 5mm ports is for liver retraction (with the use of a liver retractor.) The other 5mm port is for additional retraction. The other two ports will be 12mm ports for grasping and dissection.
The lesser omentum is entered, and grasping instruments will be used to dissect tissue and nodes. The left gastric artery and vein will be ligated, possibly using clips, L hook cautery, and laparoscopic scissors. There will be a lot more dissection done.
A GIA stapler will be used for gastric tubulization. The esophagus will be mobilized a little bit more, followed by more dissection, eventually leading to a cervicotomy and the esophagus being isolated. The esophagus and gastric tubule (made with the stapler) will be pulled through the cervicotomy and an esophagogastric anastomosis will be done.
A nasogastric tube will be placed, followed by a feeding tube, and the incisions will be closed.
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