Laparoscopic transhiatal esophagectomy for esophageal cancer

The incidence of esophageal cancer has increased over the last several decades, and the incidence of adenocarcinoma now surpasses that of squamous cell carcinoma. Esophagectomy is the best curative option for the treatment of resectable esophageal cancer but is a complex operation with significant morbidity and mortality. While the overall morbidity and mortality in those who are surgically treated has declined, approaching 40–50 % and 8–11 %, respectively, it is still significant.Over the past decade, minimally invasive esophagectomy (MIE) has been gaining favor as an attractive alternative to open resection with the potential to reduce surgical trauma, decrease morbidity, and shorten the length of hospital stay. Laparoscopic techniques were first adapted into the field of esophageal disease in 1991 with laparoscopic fundoplication, performed by Dallemagne et al. With this, the shift toward minimally invasive esophageal surgery began. Traditional approaches via open transhiatal or transthoracic (Ivor Lewis) resections were first ˵hybridized˶ with minimally invasive techniques, where parts of the procedure were performed in a minimally invasive fashion and other parts via standard incisions. In 1993, Collard and colleagues published their initial experience with thoracoscopic mobilization of the esophagus. The first esophagectomy performed completely via laparoscopy through a transhiatal approach was in 1995 by DePaula et al. In 1999, Watson et al. first described a completely minimally invasive Ivor Lewis technique.