Laparoscopic transhiatal esophagectomy for advanced thoracic esophageal cancer

We performed transhiatal subtotal esophagectomy under laparoscopic guidance to reduce the invasiveness of subtotal esophagectomy while preserving dissectional accuracy. In six cases of advanced thoracic esophageal cancer with distant metastasis, we used a special type of handpiece of ultrasonic surgical aspirator (CUSA) for laparoscopic surgery to dissect the esophagus from surrounding tissues and to isolate vessels entering it while viewing with the video monitor. Hemostasis of isolated vessels was effected by clips or electrocoagulation. There was no massive bleeding from the mediastinum during the operation, nor was there postoperative bleeding or infection. All patients regained normal swallowing ability and were discharged. Transhiatal esophagectomy under laparoscopic guidance is considered a safe, less invasive operative treatment for patients who are suffering from advanced thoracic esophageal cancer.