Thoracoscopic Esophagectomy in Supine Position

Background: Esophageal cancer needs major surgery due to its anatomic position, which is followed by high morbidity in most patients. Thoracotomy, a previously used method, was accompanied by high pulmonary complications, had physical limitations, and low tolerance of patients. Thoracoscopic esophagectomy is a new suitable method with less morbidity. Objectives: The present study aimed to investigate the results of performing three phases of esophagectomy through laparoscopy and thoracoscopy in supine position without frequent changes in patients’ position. Patients and Methods: This is a prospective study of 15 selected patients who underwent laparoscopic thoracoscopic esophagectomy and received preoperative radiotherapy between 2010 and 2011. At first, laparoscopic gastrolysis was carried out and then, transhiatal esophageal release was performed (up to the upper region); thereafter the upper esophagus was exposed by thoracoscopy in supine position and easily released. Results: The mean duration of esophagectomy was 70 minutes and the total operation 180 minutes. The mean amount of bleeding during surgery was 250 cc. Conversion to open approach occurred only in one patient out of 15. No cases of anastomotic leakage or pneumonia was observed. Also, no case of mortality was reported. Conclusions: Thoracoscopic esophagectomy can be easily performed in supine position and in a short time. .