title: Video-assisted mediastinoscopic transhiatal esophagectomy combined with laparoscopy for esophageal cancer.
abstract: BACKGROUND
  Minimally invasive transhiatal esophagectomy for esophageal cancer includes mediastinoscopic and laparoscopic transhiatal esophagectomy. It is inadequate in both two techniques. It is impossible to dissect the lower esophagus with single mediastinoscopy or the upper and middle esophagus with single laparoscopy. We use mediastinoscopy combined with laparoscopy to dissect the whole esophagus and stomach including lymph node dissection. In addition, laparoscopic gastric mobilization leads to less trauma than an open gastroplasty.
  
  
  METHODS
  40 cases of video-assisted mediastinoscopic transhiatal esophagectomy were performed and divided into two groups.32 patients were received surgical therapy of single mediastinoscopic esophagectomy with open gastroplasty in group A, while 8 patients were received surgical therapy of mediastinoscopic esophagectomy combined with laparoscopic lower esophageal and gastric dissection in group B. The perioperative complications were recorded.
  
  
  RESULTS
  Video-assisted mediastinoscopic transhiatal esophagectomy was performed successfully both in group A and B. It suggested that mediastinoscopy combined with laparoscopy be better than single mediastinoscopy because of less blood loss, less pain, shorter ICU stay and complete lower mediastinal lymph nodes resection.
  
  
  CONCLUSIONS
  Video-assisted mediastinoscopic transhiatal esophagectomy combined with laparoscopy is a safe and minimally invasive technique with whole esophagus and mediastinal lymph node dissection in the clear visualization of the mediastinum, reducing the abdominal trauma.
authors.affiliation: Department of Cardio-Thoracic Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, PR China.
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
authors.forename: Lei
authors.initials: L
authors.lastname: Xue
authors.forename: Ming
authors.initials: M
authors.lastname: Qiu
authors.forename: Xiangmin
authors.initials: X
authors.lastname: Zheng
authors.forename: Lei
authors.initials: L
authors.lastname: Zhong
authors.forename: Xiong
authors.initials: X
authors.lastname: Qin
authors.forename: Zhifei
authors.initials: Z
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome