Technique of endoscopic mediastinal dissection of the oesophagus

Conventional transhiatal dissection of the oesophagus is usually performed without visual control. The attendant danger of this is that complications such as bleeding and tracheal lesions may be overlooked. This problem can be avoided by the use of an endoscopic operation system. This report describes a new technique of endoscopic microsurgical dissection of the oesophagus (EMDOE) and the results of the first 35 cases. Under visual control with a specially designed mediastinoscope the soft tissue surrounding the oesophagus is carefully dissected, and the oesophageal blood vessels can be safely exposed, coagulated and divided. The dissection begins cervically and proceeds along the oesophagus down to the oesophagocardiac junction. A simultaneously working abdominal team helps remove the oesophagus, which is then replaced by a stomach tube. Although the method is still under evaluation, results to date have been especially good for small distal tumors, especially adenocarcinomas.