561. video assisted thoracoscopic esophagectomy with aberrant vascular anatomy

Abstract Aberrant right subclavian artery is an important vascular anomaly for upper mediastinal dissection in esophagectomy. We encountered a patient with this aberrant vascular anatomy, which was identified in preoperative CT scan. Operative video was taken in the consent of patient and saved for further educational purpose. This was a 67 years old male with advanced middle thoracic esophageal tumour. Biopsy confirmed squamous cell carcinoma. He underwent trimodality treatment after multidisciplinary team discussion. Neoadjuvant chemoradiotherapy was completed 6 weeks before the surgery. The patient underwent minimally invasive McKwown esophagectomy with complete mediastinal dissection. The patient was put in semiprone position with bronchial block for one lung ventilation. The aberrant anatomy was successfully identified intraoperatively, and the operation was uneventful. The total operative time was 6 hours 39 mins and the total blood loss was 120ml. The patient ran an uneventful recovery and was discharged on postoperative D10. To be able to acknowledge this unusual anatomy in preoperative imaging and clearly identify it intraoperatively are the keys to prevent inadvertent injury and massive bleeding.