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. 2024 Sep 28;3(1):201-205.
doi: 10.1016/j.atssr.2024.09.011. eCollection 2025 Mar.

Transcervical Endoscopic Esophageal Mobilization: An Approach to Transhiatal Esophagectomy

Jennifer Livschitz  1 , Joshua Melamed  1 , Britton Donato  1 , Amy Yoonjin Lee  1 , Huaying Dong  2 , Aniko Szabo  3 , William B Tisol  4 , Paul L Linsky  1 , Mario G Gasparri  1 , David W Johnstone  1
Affiliations

Transcervical Endoscopic Esophageal Mobilization: An Approach to Transhiatal Esophagectomy

Jennifer Livschitz et al. Ann Thorac Surg Short Rep. .

Abstract

Background: Transcervical endoscopic esophageal mobilization (TEEM) is an approach to transhiatal esophagectomy that aims to minimize blood loss and decrease the operative time commonly associated with traditional transhiatal technique.

Methods: A retrospective chart review was conducted on patients who underwent TEEM esophagectomy between 2009 and 2020. Baseline characteristics, perioperative outcomes, and postoperative complications were recorded. To report survival, a Kaplan-Meier survival plot was developed using SAS software (SAS Institute).

Results: A total of 241 patients underwent TEEM esophagectomy. The mean operative time was 185.1 ± 59.3 minutes, blood loss was 251.4 ± 212.3 mL, the number lymph nodes dissected was 13.6 ± 6.2, and the length of stay was 11.9 ± 8.5 days. In the postoperative setting, 68 (28.2%) patients experienced hoarseness, 62 (25.7%) had postoperative atrial fibrillation, 30 (12.4%) had an anastomotic leak, and 12 (4.6%) experienced chylothorax. The overall 30- and 90-day mortality rates were 2.1% (5 of 241) and 4.6% (11 of 241), respectively. The median overall survival was 2.36 years, with 60% 3-year survival and 40% 5-year survival.

Conclusions: TEEM esophagectomy is a safe approach with acceptable postoperative morbidity and mortality and shorter operative times compared with historical norms.

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Figures

Figure 1
Figure 1
View of the anterior dissection plan at the level of the carina. The esophagus lies posterior to the dissector. (L, left.)
Figure 2
Figure 2
Completed posterior dissection at the level of the midesophagus, including a view of the descending aorta. The esophagus lies anterior to the scope hood. (V., vein.)
Figure 3
Figure 3
There was a median survival of 2.36 years, 3-year overall survival was 60.1%, and 5-year overall survival was 40.5%. The CI is 95%.
Supplementary Figure 1
Supplementary Figure 1
See this image and copyright information in PMC

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