Vagal-sparing esophagectomy allows for curative tumor resection with better functional outcome and reduced postoperative morbidity, and minimally invasive esophagectomy has the advantage of avoiding the morbidities associated with big thoracoabdominal incisions. The video tutorial demonstrates our technique of preserving both vagus nerves and their celiac and hepatic branches in the abdomen during the thoracoscopic and laparoscopic phases of minimally invasive esophagectomy, with 2-field lymphadenectomy, for esophageal carcinoma. Four ports are used for thoracoscopic mobilization of the esophagus. Both vagus nerves are identified, encircled and suspended with a vascular loop and carefully separated from the esophageal wall along its whole length from above downwards beginning with the left vagus nerve then the right one. Five ports are used for laparoscopic gastric mobilization and preservation of the hepatic and celiac vagal branches. Care should be taken during ligation and division of the left gastric artery to avoid injury of the celiac branch of the vagus nerve. Resection of the common hepatic artery and left gastric artery group of lymph nodes is performed.
© The Author 2016. Published by MMCTS on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.