Minimally invasive thoracoabdominal esophagectomy in a morbidly obese patient.

Open approaches to esophagectomy include transhiatial, Ivor-Lewis, left thoracoabdominal, and McKeown, each with inherent advantages and disadvantages. Minimally invasive esophagectomy most commonly refers to a minimally invasive Ivor-Lewis style approach, although transhiatial and McKeown approaches have also been described. A minimally invasive thoracoabdominal esophagectomy has not yet been reported. This minimally invasive approach offers the same advantages as the open thoracoabdominal procedure: excellent exposure, evaluation for resectability before gastric mobilization, and no need for intraoperative repositioning. We describe a minimally invasive thoracoabdominal esophagectomy, the technique, and advantages of this approach in a morbidly obese patient with esophageal cancer.