STEP 3Transection of the esophagus

During dissection of the subcarinal lymph nodes, attention must be paid to avoid injuring the mainstream bronchi. The subcarinal nodes should remain attached en bloc to the specimen.

An Endo GIA II vascular stapler is used to divide the azygos vein. The vagus nerve is divided by ultrasonic shears cephalad to the azygos vein.

Finally, the esophagus is transected at the level of the thoracic inlet with the help of another Endo GIA II stapler magazine. The specimen is removed later through the open hiatus during reconstruction. Alternatively, the esophagus can be divided by stapler distally at the level of the hiatus and removed by one of the port incisions, which should be enlarged to 3-4cm for this purpose. The operation is completed by inserting a single 26-Fr. chest tube through the camera port, and the other port sites are closed with absorbable running sutures.

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