Subtotal esophagectomy and retro-sternal gastric tube replacement, after Akiyama, by a minimal invasive approach, for severe primary megaesophagus

A case of severe megaesophagus is described. A minimal invasive approach was considered, ie gastric mobilization and retro-sternal tunnel creation by laparoscopy, freeing the upper esophagus, and eso-gastric anastomosis through a left-sided neck incision. The sub-total esophagectomy was finally carried out by a right thoracoscopy, with the patient in prone position. The procedure was similar to Akiyama’s approach published in the early 70’ies, except being fully laparoscopic and thoracoscopic. [10’07’’ edited video]

The advantages of the chosen procedure steps are highlighted.