Clinical Data

The best approach to esophagectomy for benign or malignant disease is still controversial. However, TT and blunt transhiatal esophagectomy remain the two most frequently performed procedures. Safety and feasibility of laparoscopic transhiatal total esophagectomy, and combined thoracoscopic and laparoscopic total esophagectomy assessed by many authors have been confirmed by Nguyen et al. who compared these two procedures with conventional esophagectomy (17,18). In the authors' opinion, the main advantages of thoracoscopy, used for mobilization of the intrathoracic esophagus, included better visualization for nodal clearance, prevention of injury to mediastinal structures during esophageal dissection, and lesser intraoperative blood loss.

The TT approach may be favorable also for the repair of bilateral Morgagni hernia, and for lysis of pericardial adhesions and avoiding complications due to uncontrolled transabdominal dissection of pericardial adhesions. This technique results in shorter hospital stay, lesser postoperative pain, and better cosmetic result (19).

Video-assisted thoracoscopy may be employed to perform radical esophagectomy with three-field lymphadenectomy. In fact, pulmonary function may be better preserved and quality of life improved while achieving equivalent long-term survival (20).

Gill et al. performed the first thoracoscopic transdiaphragmatic adrenalectomy in three patients (right side two, left side one).

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