RT Book, Section A1 Hunter, John G. A1 Spight, Donn H. A1 Sandone, Corinne A1 Fairman, Jennifer E. SR Print(0) ID 1162529920 T1 Two- and Three-Field Esophagectomy T2 Atlas of Minimally Invasive Surgical Operations YR 2018 FD 2018 PB McGraw-Hill Education PP New York, NY SN 9780071449052 LK accesssurgery.mhmedical.com/content.aspx?aid=1162529920 RD 2024/11/09 AB The technique of minimally invasive esophagectomy (MIE) can be applied to almost any condition for which resection is indicated. Current indications include neoplasms, end-stage achalasia, esophageal perforation, Barrett esophagus with high-grade dysplasia, and complications of severe gastroesophageal reflux disease (GERD), especially undilatable strictures. Although initial experience with MIE primarily involved patients with Barrett esophagus and high-grade dysplasia, it has evolved to include most patients with resectable malignant lesions, including those with nodal involvement and patients who have undergone prior neoadjuvant chemoradiation therapy. Although there are no absolute contraindications for MIE, resection of large bulky tumors, reoperative upper abdominal or thoracic operations, and the need for colon interposition would commonly necessitate an open approach. Occasionally, a patient may be a candidate for a “hybrid” procedure: a patient with previous mediastinitis may need a thoracotomy and laparoscopy, or a patient with multiple previous abdominal operations may need a laparotomy but has no contraindication to thoracoscopy. There are many variations of MIE, but three approaches predominate: (1) thoracoscopic and laparoscopic dissections with cervical anastomosis (three-field esophagectomy), (2) laparoscopic and thoracoscopic dissections with intrathoracic anastomosis (Ivor-Lewis technique), and (3) laparoscopic transhiatal technique with cervical anastomosis (inversion esophagectomy) (Figure 1). In this chapter we describe the first two operations; laparoscopic transhiatal esophagectomy is described in Chapter 22.