Three-field minimally invasive esophagectomy: current results and technique

The adoption of minimally invasive esophagectomy has increased worldwide since its first description more than 15 years ago. The technique has evolved from a transhiatal to a 3-hole McKeowan approach and, more recently, to a minimally invasive Ivor Lewis approach. We reviewed the technique and results of 3-hole minimally invasive esophagectomy. We favor thoracoscopic esophageal mobilization with the patient in a lateral decubitus position, although other groups have reported this with a prone or robotic approach. Several series have demonstrated low perioperative mortality with minimally invasive esophagectomy. A major advantage compared with esophagectomy with thoracotomy is a lower incidence of respiratory complications, which have been shown to be a significant predictor of mortality in other studies.