The phreno-esophageal ligament is incised using endo-scissors. Dissection begins on the right crus and then moves to the left crus. The right crus is then dissected downward, and the esophagus is encircled with a Penrose drain for traction, via the left subcostal port. The Penrose drain is maintained in position for traction by approximation with a 3-0 endoloop.
Mediastinal dissection is then carried out using blunt instruments and acoustic scalpel, staying close to the esophagus until the diverticular pouch is reached.
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