A double-lumen tube for single lung ventilation is placed by the anesthetist with great care, as the quality of single lung ventilation is crucial for the procedure.
The patient is brought into a left-sided position as for a conventional posterolateral thoracotomy.
Special short and oval trocars for thoracoscopy reduce the danger of intercostal artery bleeding and increase the degree of freedom of instrument handling. The trocar position should be adjusted according to tumor localization, and lung retractors are needed for exposure.
Position of the patient and of the trocars is shown in a patient with esophageal carcinoma adjacent to the tracheal bifurcation.
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