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J Thorac Cardiovasc Surg. 2012 Sep;144(3):S63-6. doi: 10.1016/j.jtcvs.2012.06.002. Epub 2012 Jun 27.

Three-field minimally invasive esophagectomy: current results and technique.

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Memorial Health University Medical Center, 4700 Waters Ave, Savannah, GA 31403, USA.


The adoption of minimally invasive esophagectomy has increased worldwide since its first description more than 15 years ago. The technique has evolved from a transhiatal to a 3-hole McKeowan approach and, more recently, to a minimally invasive Ivor Lewis approach. We reviewed the technique and results of 3-hole minimally invasive esophagectomy. We favor thoracoscopic esophageal mobilization with the patient in a lateral decubitus position, although other groups have reported this with a prone or robotic approach. Several series have demonstrated low perioperative mortality with minimally invasive esophagectomy. A major advantage compared with esophagectomy with thoracotomy is a lower incidence of respiratory complications, which have been shown to be a significant predictor of mortality in other studies.

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