Minimally invasive esophagectomy

Background: Esophagectomy can be a formidable operation even in experienced hands. Methods: Critical appraisal towards minimal invasive esophagectomy. Results: The complications are often lethal. Patients developing postoperative pneumonia after open esophagectomy have up to a 20% mortality rate. In an effort to reduce the morbidity and mortality of open esophagectomy, minimally invasive techniques have been developed. This is a challenging procedure technically, but offers the chance to lessen complications and improve survival. The learning curve is steep. Proper port placement, patient positioning, and facile use of mechanical staplers is mandatory. However, the largest published series to date of minimally invasive esophagectomies [MIE] showed a 1.4% mortality rate, an 11% anastamotic leak rate, and lowered lengths of stay. The evolving Pittsburgh experience has resulted in technical modi. cations like narrower gastric pouches, Ivor Lewis type anastamoses, and more complete lymph node resection. Conclusions: This paper discusses the background, techniques, challenges, and future direction for using this technique to treat esophageal disease.