The availability of modern laparoscopic and thoracoscopic techniques as well as videoendoscopy has promoted the development of techniques for minimally invasive esophagectomy. In principle, two techniques have been established and clinically evaluated so far. Thoracoscopic esophagectomy is, in theory, an analog procedure for transthoracic en-bloc esophagectomy, but is in use in only a few centers because it is technically demanding, requires single lung ventilation over extended time periods and has not shown, clinical benefits over conventional open esophagectomy in larger series so far. Radical transhiatal esophagectomy with mediastinoscopic dissection of the esophagus (endodissection) was established in 1990 by Buess and coworkers and clinically tested in our own institution. The method is feasible and safe, and endo-dissection allows for mobilization of the proximal thoracic esophagus under direct vision and enables mediastinoscopic lymph node sampling and reduces peri- and postoperative complications compared to conventional transhiatal esophagectomy.
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