PD08.08. Transcervical and Transabdominal Double Single-Port Minimally Invasive Esophagectomy: Implementation and Surgical Technique

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – technique Esophagectomy remains the cornerstone curative treatment for resectable esophageal cancer, yet conventional transthoracic approaches are associated with substantial pulmonary morbidity. A transcervical–transabdominal dual single-port minimally invasive esophagectomy (TATDS-MIE) avoids thoracotomy while preserving oncologic radicality, but standardized technical descriptions are limited. Indicated patients include thoracic esophageal cancer staged cT1b–2N0M0 or downstaged disease after neoadjuvant therapy with anticipated R0 resection. Under general anesthesia in the supine position, a left cervical incision enables CO₂-assisted mediastinoscopic esophageal mobilization and upper mediastinal lymphadenectomy with recurrent laryngeal nerve preservation. Dissection proceeds along the esophagus to the diaphragmatic hiatus. Through a 3–5 cm upper midline abdominal single-port incision, laparoscopic gastric mobilization, abdominal lymphadenectomy, pyloroplasty, and extracorporeal gastric conduit formation are performed. The conduit is delivered through the posterior mediastinum to the neck, followed by layered hand-sewn cervical esophagogastric anastomosis. Mediastinal or cervical drainage is placed as required. The entire procedure is completed without thoracic access or intraoperative repositioning. In an initial clinical series, the technique was completed successfully in the majority of patients without conversion to thoracotomy. Adequate en-bloc esophageal mobilization and systematic mediastinal–abdominal lymphadenectomy were achieved through the dual single-port approach. The supine, non-transthoracic strategy facilitated stable anesthesia management and avoided single-lung ventilation. Early outcomes demonstrated low pulmonary complication rates, acceptable operative time, and oncologic metrics comparable to multi-port minimally invasive esophagectomy, including negative margins and sufficient lymph node yield. Cervical layered anastomosis allowed safe reconstruction with a low incidence of severe leakage or stenosis. These findings suggest that radical resection can be accomplished while minimizing surgical trauma. Transcervical and transabdominal dual single-port esophagectomy is a feasible non-transthoracic technique that combines minimal invasiveness with oncologic adequacy. By avoiding thoracic entry and patient repositioning, it may reduce pulmonary morbidity while maintaining radical lymphadenectomy. This standardized “how-to” approach provides a reproducible option for selected patients and warrants further prospective evaluation.