[Video-assisted esophagectomy for carcinoma of the esophagus, using thoracoscopy or mediastinoscopy].

To reduce the high morbidity rate associated with esophagectomy for esophageal cancer, thoracoscopic approach has been recently introduced. However thoracoscopic esophagectomy has been performed as a palliative operation like the transhiatal esophagectomy. We have developed a technique of video-assisted thoracic surgery (VATS) using thoracoscopy or mediastinoscopy as a radical esophagectomy. For the extensive lymph node dissection, especially along bilateral recurrent nerves, could be successfully performed in more than 20 patients by VATS with thoracoscopic instruments through the usual thoracotomy. And we have also applied VATS with small thoracotomy to the radical esophagectomy. Using this technique, we could performed esophagectomy almost same as the radical esophagectomy through usual thoracotomy even in small number of cases. Furthermore, disadvantages of the transhiatal esophagectomy, inherent in the blind dissection involved, was almost conquered by VATS using mediastinoscopy. These initial results of ours indicate that video-assisted esophagectomy is a feasible procedure as the radical operation for esophageal cancer.