Related Experiment Video
Updated: Oct 13, 2026
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
A left thoracic approach in a prone position for thoracoscopic thoracic duct ligation in a patient with
Kiyotomi Maruyama1, Kou Shimada1, Toshikazu Hamanaka1
1Department of Surgery, Suwa Red Cross Hospital, 5-11-50 Kogandoori, Suwa, Nagano, 392-0027, Japan.
Introduction:
We debate whether or not to approach from right thorax for the left chylothorax after esophagectomy.
Presentation Of Case:
A 50s-year-old female underwent right-sided thoracoscopic esophagectomy with three-field lymphadenectomy for esophageal carcinoma (type 0-IIa, 3.4×2.2cm, T1bN0M0, Stage IA), followed by reconstruction with esophagogastric anastomosis through the posterior mediastinum. The thoracic duct was excised and ligated. The left thoracic drainage increased to 2115mL/day on the fifth postoperative day. Thoracic duct injury was diagnosed, and surgery was performed on sixth postoperative day. With the patient in a prone position, the thoracic duct was ligated successfully under thoracoscopy in the left thorax. The leakage point was found in the crushed duct by 8.8-mm titanium clips. Then, we performed mass ligation of the thoracic duct with 11-mm titanium clips below the leakage point after careful dissection. The surgery took 58min, with an estimated total blood loss of 0g.
Discussion:
Although thoracic duct is anatomically located on the right side of the descending aorta, we employed a left-sided thoracoscopic approach due to the chylous leakage in the left thorax. With the patient in the prone position, surgeons can easily convert from a left thoracic approach to a right thoracic approach immediately without postural change if the thoracic duct cannot be found in the left thoracic cavity.
Conclusion:
This technique is useful and should be considered for patients with left chylothorax.
