[Esophageal operations with thoracoscopy]

Between 01.07.1992 and 30.06.1997 we performed thoracoscopic esophagomyotomies in seven patients suffering from achalasia cardiae, and 6 thoracoscopic mobilization of the esophagus because of esophageal cancer. The necessary background for thoracoscopic operations are: practice in minimally invasive surgery, isolated intubation, appropriate instrumentation and readiness for immediate thoracotomy. Following the myotomy, oral feeding started on the 2nd postoperative day. The mean discharge of the patients was on the 6th postoperative day. We compared the pre- and post-operative conditions 6 weeks following the operation x-ray, esophago-gastroscopy, manometry, pH-measurements were performed. Good result of the operations were: all examinations showed marked improvement and all patients had better swallowing and 3 to 9 kg increase of body weight. Thoracoscopic mobilization has been attempted on nine occasions. Thoracotomy was necessary in 3 patients because of a perforation of the left main bronchus, bleeding and tumor infiltration to surrounding areas. The mean mobilization time was 4 hours, but the time original 6 hours with practice was reduced to less than 3 hours. One patient died because of pulmonary complication, recovery of other patients was uneventful.