Minimally invasive transhiatal esophagectomy

Esophagectomy is used for the treatment of esophageal cancer as well as benign disease. Transhiatal esophagectomy with a cervical anastomosis was reported by Orringer et al. in 1978 and developed into a safe, reproducible, oncologically sound procedure. The advantages compared to other types of esophagectomies are the avoidance of thoracic incisions, which decreases respiratory complications; and a cervical anastomosis, which is less morbid if it leaks. The main criticism is an incomplete thoracic lymph node dissection, since the mediastinal dissection is performed bluntly. There is no clear difference in oncologic outcomes when comparing the transhiatal esophagectomy to other types. The first robotic transhiatal esophagectomy was reported by Horgan et al. in 2003, with a robot-assisted abdominal portion and an open cervical portion. Since then, transhiatal esophagectomy with a combination of robot-assisted and video-assisted approaches in the abdomen and neck have been described. In this article, we describe a technique in performing a minimally invasive transhiatal esophagectomy, with a robot-assisted abdominal and video-assisted cervical approach. Using a camera in both the abdominal and cervical portions of the procedure allows a complete thoracic lymph node dissection.