Minimally Invasive Ivor Lewis Esophagectomy

Clinical History:

• Onset symptoms: worsening dysphagia with mild weight loss, NRS 2.
• CEA 10 ng / ml, Ca19.9 51 U / ml
• Endoscopic diagnosis of adenocarcinoma of the lower third of the esophagus involving the cardia. HER2 +++.
• CT staging: locally advanced neoplasia with pathological periesophageal lymph nodes.
• Neoadjuvant treatment: Cisplatin, 5 fluorouracil, Trastuzumab. Non toxicity.
• At restaging, partial response to treatment.

Technique description:

This is a two-stage surgical procedure consisting in the resection of both the distal part of the esophagus and the gastroesophageal junction. Abdominal and mediastinal lymphadenectomy is usually performed. The operation starts with an abdominal approach, followed by a thoracic approach. After mobilization of the distal esophagus, a gastric conduit is created using a surgical linear stapler; the distal esophagus, the gastroesophageal junction and the gastric conduit are then pulled into the thoracic cavity through the hiatus. The type of anastomosis between the proximal esophagus and the gastric conduit depends on the surgeon's preference and there is currently no standardization. We will be showing the minimally invasive approach with thoracic end to side circular mechanical anastomosis.

Procedure steps:

Abdomen

    1. Gastrolysis

    2. Abdominal lymphadenectomy

    3. Creation of gastric tube

Thorax

    4. Esophageal dissection

    5. Mediastinal lymphadenectomy

    6. Resection of the specimen

    7. Esophago-gastric anastomosis

    8. Paravertebral analgesia

Trainings Objectives:

• Technical Tips & tricks
• Sharing of clinical experiences
• Validation of minimally invasive esophageal surgery