Uniportal video-assisted thoracoscopic surgery Ivor Lewis esophagectomy: surgical technique

Minimally invasive approaches have started to rapidly replace open surgical techniques especially in the last decade. It has been shown in many publications that similar surgical outcomes are obtained by causing less morbidity compared to open surgery. It is known that video-assisted thoracoscopic surgery (VATS) esophagectomy technique provides less pulmonary complications, bleeding and shorter hospital stays compared to the open technique. On the other hand, uniportal VATS is at least comparable in pain and morbidity to multi-portal VATS in patients with lung resection. There is limited data comparing the uniportal and multi-portal technique in esophageal surgery, but it is expected to yield similar results. Uniportal VATS esophagectomy technique was refined in the search for the least invasive technique with smaller incision, lesser number of ports. In this technique, a 4 cm incision is placed on the 6th intercostal space. Intrathoracic anastomosis is performed with side to side completely stapled technique. The uniportal VATS esophagectomy technique has comparable results with other minimally invasive and open techniques. As the least invasive esophagectomy technique, uniportal VATS Ivor Lewis esophagectomy offers similar surgical and oncological results to the patients from a single incision. Technical details for how to overcome difficulties in the uniportal technique such as instrumentation and positioning in the limited space are explained within this article.