THORACOSCOPIC TECHNIQUES FOR DISEASE OF T HE ESOPHAGUS

Some malignant and benign diseases of the esophagus are generally trea ted through a thoracotomic approach. While this may be justified in th e curative treatment of cancer, thoracotomy may be avoided for benign diseases if good functional results can be obtained through a minimall y invasive approach. Long-term results with careful clinical and manom etric monitoring of patients operated on for epiphrenic diverticula ha ve to be considered to define the possible role of thoracoscopic appro ach to this disease since a laparoscopic approach, which includes tran shiatal diverticulectomy, myotomy, and fundoplication, seems to have e xcellent results. As for leiomyomas thoracoscopy represents the first choice approach since it allows a complete removal of the benign tumor with a limited access. In case of malignant diseases, thoracoscopic e sophagectomy has in our opinion few indications. Extent of lymphnodal dissection appears to be the major limiting factor of the technique. M oreover, high-risk patients need anyway a double-lumen intubation and a prolonged single-lung ventilation. Modifications of respiratory func tion after thoracoscopy have to be compared with those occurring after thoracotomy and after transhiatal esophagectomy. Studies on lymphaden ectomy and on respiratory physiopathology will help in define a possib le role of this approach.