Surgical Treatment for Esophageal Cancer by Means of Thoracoscopy or Laparoscopy

Takashi Akaishi

Department of Surgery, Akaishi Hospital

In the surgical treatment for the esophageal cancer, thoracoscopic mobilization of the esophagus has been indicated for patients who had the primary lesion invading the mucosal musclelayer or deeper but up to the adventitia. The patients who were presumed not to tolerate with one-lung ventilation during the period of the mediastinal portion of the surgery has been excluded. The lung was kept away from the surgical field, using "thoracoweb" maneuver, and four hands, the surgeon's two and the assistant's two, participated in the mediastinal procedure, facillitating meticulous lymphadenectomy. It made no difference of the patients' survival whether the thoracoscopy was adapted or not. The thoracoscopic esophagectomy marked a better recovery in the patients' vital capacity than the conventional thoracotomy did. Laparoscopic mobilization of the stomach came to be demanded because the decline of the vital capacity was still observed during the early postoperative period even by thoracoscopy. No standard procedures have been established, and many technical proposals have been tried out for practice. The author has proposed to use a spacer balloon which is placed in the omental sac and is inflated to lift the stomach. The balloon is utilized for retracting the stomach in a less invasive manner that avoides retracting the stomach directly.

Key words
thoracoscopy, laparoscopy, esophagectomy

Reprint requests
Takashi Akaishi Akaishi Hospital 22-42 Hanadate-machi, Shiogama, 980-0023 JAPAN

Accepted
May 25, 1999

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