Hand-assisted laparoscopic transhiatal esophagectomy using the dexterity pneumo sleeve

Abstract

Background: As the use of laparoscopic techniques have expanded to more complicated procedures, limitations of laparoscopy have begun to be realized. To help regain the ability to palpate and bluntly dissect tissues, and handle larger organs, surgeons have begun to utilize devices which allow the surgeon's hand to be inserted into the abdomen during laparoscopic procedures. One such devices is the Dexterity Pneumo Sleeve, which was used here to perform transhiatal esophagectomy in two patients.

Methods: Two patients with adenocarcinoma of the esophagus underwent hand-assisted laparoscopic transhiatal esophagectomy. The stomach mobilization was carried out using laparoscopic technique facilitated by the use of the surgeon's hand. Blunt dissection of the esophagus through the hiatus was then carried out. Dissection of the proximal esophagus and creation of a cervical esophagogastric anastomosis was then performed in the neck through a cervical incision.

Results: The Pneumo Sleeve proved useful for handling the stomach, as well as, blunt dissection of the esophagus while still maintaining the benefits of laparoscopy, including small incisions, and no postoperative ileus.

Conclusion: Hand-assisted laparoscopic esophagectomy can be carried out with good, early, postoperative recovery.

Figure 1.

Incision and port placement

Figure 2.

Surgeon and assistant position for abdominal portion of procedure.

Figure 3.

Surgeon and assistant position for mediastinal portion of procedure.