ABSTRACT
Introduction .............................................................................................................................208 Surgical A ccess ........................................................................................................................208 Esophagectomy by Video-thoracoscopy (E V T ) .............................................................. 209 Critical Analysis......................................................................................................................213 Technical M odalites o f Video-assisted Esophagectom y .............................................. 215
INTRODUCTION
The search for a safe and less traumatic procedure for esophagectomy has con stantly challenged surgeons. Early attempts at esophagectomy were conducted through an extrapleural approach since thoracotomy was impossible.1'3 With ad vances in critical care and anesthesiology, surgeons adopted the thoracic approach as the best alternative for esophagectomy.4 The high incidence of malnutrition and respiratory insufficiency among patients with esophageal cancer resulted in a revival o f esophagectomy without thoracotomy in order to minimize periopera tive surgical morbidity.5'9 With the advent of videoscopic and minimally invasive surgery, thoracic procedures are now being performed via this modality, includ ing esophagectomy. Currently video-assisted esophagectomy is technically feasible; however its advantages as compared to conventional techniques remain question able. Furthermore several questions regarding operative technique, preservation of oncological principles, postoperative adjuvant management and long-term sur vival remain unanswered.
