Video-assisted transsternal radical esophagectomy: Three-field lymphadenectomy without thoracotomy for esophageal cancer

To reduce the invasiveness of radical esophagectomy, we developed a new app roach: video-assisted transsternal radical esophagectomy (VATRE). This arti cle presents the operative techniques and our initial results. In our new p rocedure, cervical U-shaped and longitudinal sternoabdominal incisions are made, and a complete midline sternotomy is carried out. Lymph node clearanc e from the neck to the upper mediastinum and from the lower mediastinum to the upper abdomen is performed under direct vision. In the middle mediastin um, a video-assisted technique is used to dissect the lymph nodes. After es ophageal resection and three-field lymphadenectomy, reconstruction is perfo rmed. One-lung ventilation is unnecessary. We have performed this procedure in two cases. These patients had no major complications and recovered more rapidly than patients undergoing conventional transthoracic esophagectomy. Our initial experience shows that VATRE is a technically feasible and less invasive procedure for cancer surgery, and it enables us to easily perform three-field lymphadenectomy.