[Total minimally invasive esophagectomy]

Esophagectomy for oncological reasons is associated with high morbidity, which was intended to be reduced by a minimally invasive approach. Main problem of the minimally invasive approach is the challenge of a safe intrathoracic anastomosis. To address this problem several methods such as a collar anastomosis instead of an intrathoracic anastomosis with poor functional outcome, hybrid techniques with an open approach to the demanding intrathoracic circular stapled anastomosis ore robotic assistance have been used. We demonstrate the minimally invasive linear stapler technique for the intrathoracic esophagogastrostomy, which can be applied quite easily even without robotic assistance.

The abdominal part is performed with the patient in French position. After division of the greater omentum along the gastroepiploic arcade and the spleen as well as the perigastric incision of the lesser omentum 6cm from the pylorus a 4,5 cm gastric conduit is created in linear stapler technique. Next an intraabdominal and transhiatal systematic lymphadenectomy is performed. For the thoracic part the patient is repositioned in a left side position. The thoracic lymphadenectomy is completed, and the specimen removed via mini-thoracotomy. For the anastomosis the esophageal stump is incised, and the gastric conduit is opened 5 cm from the oral resection line. Once the stapler is fired and removed the remaining opening is hand-sewn in a modified double-layer technique.

The side-to-side esophagogastrostomy in linear stapler technique seems to be a quite easily feasible and safe alternative for the reconstruction after minimally invasive esophagectomy. To confirm this, the method is currently investigated in a randomized controlled trial.