Laparoscopic Transhiatal Esophagectomy

Mayo stand and back table instruments for Laparoscopic Transhiatal Esophagectomy surgery setup

Clamping & Occluding

  • Curved Hemostat

    Curved Hemostat

  • Kelly Forceps

    Kelly Forceps

Cutting & Dissecting

  • #3 Knife Handle

    #3 Knife Handle

  • L Hook Cautery

    L Hook Cautery

  • Laparoscopic Metz Scissor

    Laparoscopic Metz Scissor

  • Metzenbaum Scissor

    Metzenbaum Scissor

  • Straight Mayo Scissor

    Straight Mayo Scissor

Grasping & Holding

  • Dissecting Laparoscopic Grasper Forceps

    Dissecting Laparoscopic Grasper Forceps

  • Laparoscopic Allis Grasper

    Laparoscopic Allis Grasper

  • Laparoscopic DeBakey Forceps

    Laparoscopic DeBakey Forceps

Misc

  • Laparoscope

    Laparoscope

  • Camera Cord

    Camera Cord

  • Light Cord

    Light Cord

Retracting & Exposing

  • Fan Retractor

    Fan Retractor

  • Fisher Style Liver Retractor

    Fisher Style Liver Retractor

  • Medium Nathanson Hook Liver Retractor

    Medium Nathanson Hook Liver Retractor

Suctioning

  • Suction Irrigator

    Suction Irrigator

  • Yankauer Suction

    Yankauer Suction

Suturing & Stapling

  • Laparoscopic Clip Appliers

    Laparoscopic Clip Appliers

  • Appel Laparoscopic Knot Pusher

    Appel Laparoscopic Knot Pusher

  • Laparoscopic Needle Holder

    Laparoscopic Needle Holder

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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