Esophagectomy

Traditionally, an esophagectomy is performed through an open approach, which involves a single large abdominal incision (called a laparotomy) and often a single incision on the side of the chest (called a thoracotomy) which involves spreading the ribs apart.

However, our thoracic surgeons at Baylor Medicine routinely perform esophagectomies using minimally invasive techniques, either a conventional minimally invasive esophagectomy (MIE) or robot-assisted minimally invasive esophagectomy (RAMIE). In contrast to a traditional “open” esophagectomy, MIE and RAMIE uses a series of small incisions (most are less than an inch long) with no spreading of the ribs. Compared to open esophagectomy, MIE and RAMIE are associated with lower complication rates, faster recovery and better quality-of-life after surgery, without compromising the quality of the operation.

In addition to the technique (open or minimally invasive), there are many types of esophagectomies. The more common types include an Ivor Lewis esophagectomy, which involves surgery through the abdomen followed by the right chest, and modified McKeown (also known as three-hole), which involves surgery through the right chest, followed by the abdomen and left neck.

The particular operation the surgeon will perform depends on the location of the problem being treated, such as the location of the tumor.

Given the discomfort and complications associated with traditional surgery, surgeons have developed less invasive techniques to remove the esophagus. Robot-assisted minimally invasive esophagectomies utilize the da Vinci Surgical System, which provides the surgeon with a magnified, 3D high-definition visual system and tiny wristed instruments, which bend and rotate with much greater flexibility than the human hand. This enables the surgeon to operate with enhanced vision, precision and control as compared with standard minimally invasive techniques.