What are the common incisional approaches of esophagectomy?

Transthoracic esophagectomy:

- A left posterolateral thoracotomy is performed.

- The esophagus is dissected from the posterior mediastinum and the esophagus is divided with a stapler.

- The stomach is mobilized and pulled up into the chest and a gastric conduit is created.

- The gastric conduit is then anastomosed to the proximal esophagus.

Transhiatal esophagectomy:

- A laparotomy is performed and the abdomen is explored.

- The abdomen is closed and the patient is placed in the right lateral decubitus position.

- A cervical incision is made and the esophagus is dissected down to the hiatus.

- The esophagus is divided and the stomach is pulled up into the posterior mediastinum and a gastric conduit is created.

- The conduit is then anastomosed to the cervical esophagus.

Hybrid approach:

- Hybrid esophagectomy combines both right thoracotomy and upper midline laparotomy.

- This approach is useful for lesions located in the distal one-third of the esophagus.

Minimally invasive esophagectomy (MIE):

- Minimally invasive esophagectomy refers to various surgical approaches performed through small incisions.

- Common techniques include:

- Thoracoscopic subtotal esophagectomy.

- Hybrid esophagectomy.

- Robotic-assisted esophagectomy.

- Transhiatal esophagectomy with hand-assisted laparoscopy.

- Thoracoscopic transthoracic esophagectomy.