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Figure 7. Drawings illustrate transhiatal esophagectomy without a thoracotomy. In A, a cervical incision parallel to the anterior border of the left sternocleidomastoid muscle (arrowhead) and an upper abdominal incision (arrow) are made. In B, the esophagus is dissected transhiatally by the surgeon passing his or her hand through the widened hiatus. Combined circumferential dissection of the esophagus through both the cervical and abdominal wounds allows the esophagus to be completely mobilized. In C, the esophagus and its adjacent structures are dissected. Lymph node dissection is also performed. Arrows indicate resection lines. In D, anastomoses are created between the remaining esophagus and the gastric tube. Straight arrow indicates the pyloromyotomy, curved arrow indicates the intrathoracic anastomosis site, arrowhead indicates the original cardioesophageal junction.
