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Figure 12. Drawings illustrate thoracoscopic port placement for minimally invasive esophagectomy. In A, four thoracoscopic ports are introduced. The camera port (10 mm) is placed at the seventh intercostal space on the midaxillary line. A 10-mm port is placed at the eighth or ninth intercostal space 2 cm posterior to the posterior axillary line for the ultrasonic coagulating shears. Two additional ports are placed, one (5 mm) posterior to the tip of the scapula and one (10 mm) at the fourth intercostal space at the anterior axillary line for retraction of the lung and esophageal countertraction during dissection. Dotted line indicates the diaphragm. In B, five abdominal ports are placed on the anterior abdominal wall: one cut-down 10-mm port in the right side of the epigastrium and four 5-mm ports in the bilateral subcostal, left epigastric, and right flank locations. Long dotted line indicates the diaphragm, short dotted line indicates the position of the neck incision. In C, a pyloroplasty (arrowhead) is performed using ultrasonic shears, and the incision is closed transversely. Then, a gastric tube (arrow) is constructed by dividing the stomach starting at the distal lesser curve while preserving the right gastric vessels. In D, an anastomosis (arrow) is created between the esophagus and the gastric tube. The gastric tube is sutured using an end-to-end anastomosis stapler.
