Esophageal resection - general and visceral surgery

After checking patient position, skin prepping and sterile draping make a midline skin incision from the xiphoid to the navel, passing the latter on the left. After transecting the subcutaneous tissue with electrocautery open the abdominal cavity along the linea alba.

Insert a circular wound edge protector, thoracic retractor and the Ulrich cable winch retractor.

Explore the entire abdominal cavity to rule out peritoneal and liver metastasis, if necessary, by ultrasonography.

Incise the lesser omentum close to the liver. As shown here, spare any atypical left hepatic artery arising from the left gastric artery. Continue the incision onto the pre-esophageal peritoneum and bluntly open the esophageal hiatus within the tissue layer separating the right crus of diaphragm from the esophagus. Expose the esophagus craniad and to the left crus of diaphragm by blunt dissection. Loop the esophagus with a Penrose drain or like to put traction on it.

After suture ligature of a phrenic vein divide the esophageal hiatus. Dissect the distal esophagus transmediastinally including the lymph nodes between pericardium, mediastinal pleura and aortic wall.