Dissection of the hiatus and the inferior mediastinum

After abdominal incision (inverse-T laparotomy and self-holding Stuhler's retractors), the hiatus of the patient should be exposed after mobilization of the left lobe of the liver.

When endodissection is nearly completed, the abdominal team widely opens the hiatus by excising portions of the crura of the diaphragm (left adherent to the specimen) and dividing the diaphragmatic vein between clamps. The periesophageal mediastinal lymphatic tissue is dissected from the pericardium and remains adherent to the specimen in "en bloc" fashion. The primary tumor should not be exposed during the operation. Both visceral layers of the pleura may be resected without problems. After complete mobilization of the esophagus by the cervical team and division of the cervical esophagus with a linear stapler, the specimen is retracted into the abdominal cavity. A lymphadenectomy in compartments I and II is always added (A-1, A-2).

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