Endoscopic surgery for esophageal diseases has certain advantages, i.e. less pain, a shorter hospital stay, earlier recovery of a normal daily life, and so on, due to the minimal access and the less invasive procedure involved. We classified endoscopic surgery for esophageal diseases into three categories based on type of operative indications; i.e., support for conventional operations, interchangeable procedures for standard open surgery, and operations feasible but still contraversial. The first category includes mediastinoscopy-assisted dissection in transhiatal esophagectomy and thoracoscopy-assisted transthoracic esophagectomy. The second includes thoracoscopic enucleation of esophageal leiomyoma, diverticulectomy, laparoscopic anti-reflux surgery for reflux esophagitis, and long myotomy for achalasia. The last category includes thoracoscopic esophagectomy with lymphnodes dissection for esophageal cancer.
We have introduced some useful techniques and instruments in this field of endoscopic surgery, such as a sheath with a transparent cap on the mediastinoscope for transhiatal esophagectomy, the intraoperative assistance of a balloon-mounted esophagoscope to facilitate the enucleation of leiomyoma in the thoracoscopic treatment for esophageal leiomyoma, and so on. Thoracoscopic esophagectomy with lymphadenectomy is still controversial because 1) we have not yet obtained a complete mediastinal lymphnode dissection; 2) we need a longer anesthesic time with unilateral lung ventilation; and 3) we can not avoid laparotomy for lymphadenectomy of celiac lymphnodes or for esophageal reconstruction. However, at present, with a combination of endoscopic and conventional surgery, endoscopy-supported esophagectomy with lymphadenectomy is one of the acceptable modalities for the treatment of esophageal cancer.
