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Title
1. Introduction
2. Endoscopy
3. Patient Positioning and Draping
4. Incision and Port Placement
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a. Initial Inspection of Abdomen
5. Open Gastrohepatic Omentum
6. Mobilize Along the Top Part of Esophageal Hiatus
7. Free Esophagus Along Right Crus
8. Skeletonize Left Gastric Artery and Vein
9. Greater Curve Dissection
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a. Entering the Lesser Sac
b. Taking Short Gastric Vessels
c. Dissecting Toward Pylorus, Preserving the Gastroepiploic
d. Dissecting Along Left Crus
10. Division of Left Gastric Artery and Vein
11. Additional Mediastinal Dissection
12. Lesser Curve Dissection
13. Gastric Conduit
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a. Add Right Lower Quadrant Port
b. Divide Vessels Along Lesser Curve
c. Thick Tissue Staple Loads to Create Conduit
14. Dissection at GE Junction
15. Mattress Suture Stomach to Specimen
16. Close Ports
17. Port Placement
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a. Camera Port
b. Posterior Inferior Port
c. Second Posterior Port
d. Retractor Port
e. Stitch in Diaphragm
f. Retract Lung
g. Suction Port
18. Dissection in Chest
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a. Inspect for Metastatic Disease
b. Take Down Inferior Pulmonary Ligament
c. Medial Pericardium Dissection
d. Lateral Chest Dissection
e. Connect Abdominal and Chest Dissection
f. Lateral Dissection of Esophagus
19. Divide Azygos Vein
20. Bring Specimen into Chest
21. Circumferentially Dissect Proximal Esophagus
22. Subcarinal Lymphadenectomy
23. Lengthen Posterior Inferior Port Incision
24. Transect Esophagus
25. Esophagus Removal and Inspection
26. Anastomosis
27. Close Gastrotomy
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a. Inject Post-Op Analgesic
b. Drain Placement
c. Inflate Lung
d. Wound Closure
28. Post-op Remarks
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Minimally Invasive Ivor Lewis Esophagectomy
Christopher R. Morse, MD
Massachusetts General Hospital
Tags:
General Surgery
Thoracic Surgery
Oncologic Surgery
Main Text
Procedure Outline
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Authors
Christopher R. Morse, MD
Filmed At:
Massachusetts General Hospital
Article Information
Publication Date
12/19/2024
Article ID
176.1
Production ID
0176.1
Volume
2024
Issue
176.1
DOI
https://doi.org/10.24296/jomi/176.1