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Ann Thorac Surg 2000;70:911-912
© 2000 The Society of Thoracic Surgeons

Discussion

Discussion

Discussion

DR MARK B. ORRINGER (Ann Arbor, MI): Doctor Luketich, this was a well-delivered paper, and I enjoyed it very much. Your technique is an extension of the concept of esophagectomy without thoracotomy, which I think has now been shown to be achievable in the majority of people needing an esophagectomy.

I do have some concerns that I would like you to address. This is not just minimally invasive esophagectomy. It is "minimally invasive gastric mobilization" as well, and the gastric mobilization is a key part of this operation. We have learned over the years, as we stopped focusing upon the actual transhiatal esophagectomy, that mobilizing the stomach in as atraumatic a fashion as possible is extremely important, and when the stomach is delivered out onto the abdominal wall, as the stapler is progressively applied, the stomach is gradually stretched and an elongated gastric tube fashioned. You do not do this with your technique. You cannot stretch the stomach in the same way when confined by the abdominal cavity. Further, you cannot palpate the tumor to see how far away you are from an EG junction tumor in applying your stapler. You also describe taking sutures into the apex of the stomach, which we are now preaching has to be traumatized as little as possible—no sutures to drains, no "beating up" the stomach so that you wind up with a contused, ecchymotic fundus when you bring it up to the neck for the anastomosis. The fact that you pull the divided esophagus (with its contained tumor) sutured to the gastric . . . [Full Text of this Article]


Related Article

Minimally invasive esophagectomy
James D. Luketich, Philip R. Schauer, Neil A. Christie, Tracey L. Weigel, Siva Raja, Hiran C. Fernando, Robert J. Keenan, and Ninh T. Nguyen
Ann. Thorac. Surg. 2000 70: 906-911. [Abstract] [Full Text] [PDF]





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