title: Early outcomes of video-assisted thoracic surgery (VATS) Ivor Lewis operation for esophageal squamous cell carcinoma: the extracorporeal anastomosis technique.
abstract: OBJECTIVE
  Although the use of a minimally invasive approach in esophageal cancer surgery is gradually increasing, it is generally performed using cervical anastomosis because of the difficulty of intrathoracic anastomosis. Here, we describe our technique for performing intrathoracic esophagogastrostomy using a typical video-assisted thoracic surgery (VATS) approach.
  
  
  METHODS
  Between September 2009 and July 2011, VATS esophagectomy and intrathoracic anastomosis was performed in 31 esophageal cancer patients with a utility incision made by a segmental rib resection to enhance the extracorporeal insertion of the end-to-end stapler. We retrospectively reviewed the clinical records of these patients.
  
  
  RESULTS
  There were no intraoperative events related to the VATS procedure. The mean VATS time was 180.2 ± 39.2 min. The mean postoperative hospital stay was 15.2 days (range, 11 to 38 d). No significant pulmonary complications were observed. Five patients developed vocal cord palsy due to radical mediastinal lymphadenectomy. No anastomotic complications such as leaking or stricture were observed. Only 1 patient had postoperative pain requiring analgesics.
  
  
  CONCLUSIONS
  Our technique can be safely and effectively performed for intrathoracic anastomosis in esophageal surgery with favorable early outcomes and reduced postoperative pulmonary complications.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea. kmkim0070@gmail.com
authors.forename: Kwhanmien
authors.initials: K
authors.lastname: Kim
authors.forename: Joon S
authors.initials: JS
authors.lastname: Park
authors.forename: Hoon
authors.initials: H
authors.lastname: Seo
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000601:surgery*; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013536:Suture Techniques; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome