Uniportal thoracoscopic and single-incision plus one port laparoscopic esophagectomy with direct vision retrosternal reconstruction for esophageal cancer a single center retrospective cohort study

Abstract

Introduction: Despite being highly invasive, esophagectomy remains the mainstay of treatment for early- and intermediate-stage esophageal cancer. With the advancement of minimally invasive techniques, single-port thoraco-laparoscopic esophagectomy has been increasingly applied in clinical practice, offering advantages in terms of improved cosmetic outcomes, reduced postoperative pain, and enhanced recovery. However, the procedure is technically demanding. In addition, the traditional posterior mediastinal route for reconstruction is associated with a relatively high risk of complications, whereas reconstruction via the substernal route may significantly reduce cardiopulmonary morbidity.

Objective: To evaluate the short-term outcomes of uniportal thoracoscopic and single-incision plus one port laparoscopic minimally invasive esophagectomy combined with direct retrosternal approach for radical esophagectomy.

Methods and analysis: The clinical data of 60 patients who underwent uniportal thoracoscopic and single-incision plus one port laparoscopic minimally invasive esophagectomy combined with direct retrosternal approach for radical esophagectomy between January 2024 and February 2025 were retrospectively analyzed. Perioperative indicators and postoperative follow-up data were recorded in detail.

Results: All surgeries were successfully completed with no conversion to open thoracotomy or laparotomy, and no perioperative deaths occurred. The mean operative time was 209.35 ± 28.57 min, the mean intraoperative blood loss was 64.17 ± 20.53 mL, and the mean number of lymph nodes dissected was 32.35 ± 11.51. The visual analog scale (VAS) scores for pain at postoperative were 2.20 ± 0.99. The average length of hospital stay was 7.92 ± 2.11 days. Ten patients developed postoperative complications, with a complication rate of 16.67%.

Conclusion: Uniportal thoracoscopic and single-incision plus one port laparoscopic minimally invasive esophagectomy combined with direct retrosternal approach is a safe and feasible technique for esophageal cancer, with potential advantages in terms of cosmetic outcomes and reduced postoperative incisional pain.

Keywords: Esophageal cancer; Radical esophagectomy; Retrosternal approach; Single-incision; Thoracoabdominal laparoscopy.

Fig. 1

Thoracic incision

Fig. 2

The mediastinal pleura was incised at the pleural apex

Fig. 3

Dissection of the lymph nodes adjacent to the right recurrent laryngeal nerve

Fig. 4

The posterior wall of the esophagus was mobilized with preservation of the thoracic duct

Fig. 5

Dissection of the lymph nodes located beneath the azygos arch

Fig. 6

The esophagus was transected

Fig. 7

The left recurrent laryngeal nerve was identified and carefully preserved

Fig. 8

The middle and lower esophagus was mobilized down to the esophageal hiatus

Fig. 9

Abdominal incision

Fig. 10

Liver retraction technique (1)

Fig. 11

Liver retraction technique (2)

Fig. 12

Liver retraction technique (3)

Fig. 13

The right gastroepiploic vascular arch was preserved

Fig. 14

Lymphadenectomy was performed along the left gastric artery, splenic artery, and common hepatic artery

Fig. 15

The esophageal stump was exteriorized

Fig. 16

The inferior pole of the spleen was mobilized

Fig. 17

The retrosternal tunnel was created under direct vision

Fig. 18

The tubularized stomach was elevated under direct vision