To reduce the high morbidity rate associated with esophageal surgery,
we have developed a technique of thoracoscopic esophagectomy. A feasib
ility study was first carried out in an animal model and a specific in
strument was developed for this purpose. Esophagectomy using a right t
horacoscopic approach was attempted in 15 patients, 13 males and 2 fem
ales whose average age was 48 years. Indications consisted of squamous
cell carcinoma in 10 patients, adenocarcinoma in 1, and caustic steno
sis in 4. We used a technique that consisted of double-lumen tracheal
intubation and the creation of five ports. The whole esophagus was mob
ilized thoracoscopically and the esophagectomy was completed through t
he abdomen. The reconstruction was achieved using a gastric pull-throu
gh, and the anastomosis was made in the neck. There were three failure
s: in 1 patient there was a large tumor, making the exposure unsafe, a
nd, in 2 patients, incomplete lung collapse made exposure of the poste
rior mediastinum difficult. These 3 cases were converted into a thorac
otomy. The thoracoscopic dissection was successful in the remaining 12
patients. The average time of the thoracoscopic stage was 125 minutes
. The postoperative course was uneventful in 10 patients. Two patients
had a left atelectasis. Although our series is limited, these initial
results indicate that thoracoscopic esophagectomy is feasible. Howeve
r, further evaluation of the technique is needed to assess its benefit
in terms of respiratory morbidity.