[Esophagectomy by video-assisted laparoscopic and trans-mediastinal approach]

The aim of study was to report our experience with an original technique of oesophagectomy without thoracotomy. The operation consists of two complementary approaches. Laparoscopic access enables the surgeon to mobilize the stomach and dissect the distal oesophagus. Cervical access allows dissection of the upper thoracic oesophagus under vision using a special videomediastinoscope. Six patients with oesophageal carcinoma or high-grade dysplasia in Barrett's oesophagus were selected for this operation over the period from October 2000 to December 2001. The operation was completed by minimally invasive access in 4 of the 6 patients. The mean duration of the operation was 240 minutes, and the postoperative hospital stay 9.5 days. One patient required endoscopic pneumatic dilatation of the pylorus 2 weeks after surgery. This technique enhances the safety of conventional oesophagectomy without thoracotomy by avoiding the "blind" dissection of the upper mediastinum. The advantages of laparoscopy include superior staging of the disease, gastric mobilization, and lymphadenectomy of the lower mediastinum. The ideal candidates for this operation are patients with high-grade dysplasia or T1-N0 adenocarcinoma arising from Barrett's oesophagus.