V-19. Minimal Invasive Thoracoscopic-Laparoscopic Esophagectomy With Two Field Lymphadenectomy in Prone position:Tips And Tricks of Surgical Technique

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – technique Minimally invasive esophagectomy (MIE) has become an established approach for esophageal cancer, offering reduced surgical trauma while maintaining oncologic adequacy. The prone position for thoracoscopic esophagectomy provides superior visualization, improved ergonomics, and reduced pulmonary compromise. We describe our standardized technique of prone-position MIE with two-field lymphadenectomy and report its technical feasibility The procedure is performed in two stages. The thoracic phase is conducted in the prone position using thoracoscopy, allowing precise mobilization of the esophagus under direct vision with en bloc mediastinal lymphadenectomy, including subcarinal, paraesophageal, and paratracheal nodal stations,aorto-pulmonary window lymph nodes. The abdominal phase is performed laparoscopically for gastric mobilization, celiac axis lymphadenectomy, and conduit formation. A cervical anastomosis is fashioned. Systematic two-field lymphadenectomy is performed. The prone approach facilitates excellent exposure of the posterior mediastinum, minimizes lung manipulation, and allows meticulous dissection around vital structures such as the aorta, trachea, and thoracic duct. The technique is associated with reduced blood loss, satisfactory lymph node yield. Prone-position minimally invasive esophagectomy with two-field lymphadenectomy is a safe, reproducible, and oncologically sound technique. It offers superior operative visualization and ergonomic advantages, enabling precise mediastinal dissection with favorable perioperative outcomes and should be considered a preferred approach in experienced centers.