The final peritoneal dissection occurs just anterior to the esophagus across the connecting arch of the diaphragmatic muscle that joins the two crus muscles (Figure 8). Once this area has been cleared, the esophagus is mobilized further with careful preservation of the left anterior and right posterior vagus nerves. About 2 to 3 cm of the esophagus should extend into the abdomen. This dissection is performed using gentle elevation and lateral retraction of the gastroesophageal junction with the shaft of an instrument. Dissection should not proceed blindly into the hiatus or above the superior or cephalad top of each crus, as a pleural opening may be created. This usually does not present a significant problem, as the positive-pressure endotracheal ventilation has greater pressure than the CO2 inflation pressure within the abdomen. In some cases, however, the opening may be repaired with a suture, and a chest tube may be required.