title: Hand-assisted endoscopic esophagectomy for esophageal cancer.
abstract: Radical esophagectomy is a highly invasive operation for esophageal cancer, and improved techniques are being sought to reduce the invasiveness of this procedure. We devised a method in which an assistant inserts their left hand into the thoracic cavity, and the operator inserts their left hand into the abdominal cavity through a small incision in the upper quadrant during an endoscopic procedure. Between 1996 and 1999, we performed endoscopic esophagectomy on 18 patients. The median number of mediastinal lymph nodes removed by thoracoscopic surgery was 20.1 +/- 9.4 and the median number of abdominal lymph nodes removed by laparoscopic surgery was 11.1 +/- 5.6. The number of nodes dissected by endoscopic surgery did not differ significantly from the number of nodes dissected by conventional thoracotomy with laparotomy. Our experience shows that endoscopic esophagectomy with reconstruction of the esophagus assisted by inserting the hand into the thoracic and abdominal cavity, for safety and certainty, is an effective technique that is much less invasive than radical esophagectomy performed by conventional thoracotomy with laparotomy.
authors.affiliation: Department of Surgical Oncology, Division of Cancer Medicine, Hokkaido University Graduate School of Medicine, N14, W5, Kita-ku, Sapporo 060-8648, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Okushiba
authors.forename: Koichi
authors.initials: K
authors.lastname: Ohno
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Itoh
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohkashiwa
authors.forename: Makoto
authors.initials: M
authors.lastname: Omi
authors.forename: Kousaku
authors.initials: K
authors.lastname: Satou
authors.forename: You
authors.initials: Y
authors.lastname: Kawarada
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Morikawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Katoh
mesh_terms: D004724:Endoscopy; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision; D008482:Mediastinum