Exposure preparation and access to the cervical esophagus

The patient is brought into a supine position and the skin is disinfected. The esophagus should be intubated with a rigid rubber tube. The abdominal wall, the anterior thorax and the left side of the neck must be completely exposed for the two operating teams (abdominal and cervical teams) (A-1).

The cervical incision is made at the anterior edge of the sternocleidomastoideus muscle. The omohyoideus muscle is divided by monopolar electrocautery and the inferior thyroid artery is divided between ligatures. The recurrent laryngeal nerve must be identified and carefully preserved during the next steps of the dissection. The nerve is best located at the point where it undercrosses the inferior thyroid artery. Further dissection of the nerve should be avoided in order to prevent secondary lesions.

The cervical esophagus is mobilized by blunt/sharp dissection and drawn laterally with the help of a silicone tube in order to gain some dissection space between the esophagus and trachea (A-2).

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