370. LOWER MEDIASTINUM DISSECTION IN THORACOSCOPIC ESOPHAGECTOMY

Background Thoracic esophagectomy is currently the preferred technique for the thoracic phase of transthoracic esophagectomy for esophageal cancer. Randomized controlled trials comparing this minimally invasive approach to the open one, demonstrated a lower rate of pulmonary complications rate, without worst long-term outcomes. Video-based learning of minimally invasive surgery is essential, especially in such a complex procedure like esophagectomy. However, resources are lacking. Therefore, we aim to conduct a video demonstration of lower mediastinum dissection of our standardized right thoracoscopy esophagectomy, in the prone position. Methods Surgery de-construction through video assessment is routinely performed in our upper gastrointestinal unit. It is fundamental for surgical training, as well as for technical skills improvement of experienced surgeons. Here we present a step-by-step approach of one of the key parts of our standardized thoracoscopic esophagectomy technique – the lower mediastinum dissection. Results Thoracoscopic esophagectomy is systematically performed in a prone position, using a bronchial blocker, 4 working ports and a pressure of 6 mmHg for pneumomediastinum. The first stage of thoracoscopic esophagectomy is the lower mediastinum dissection. Three main steps compose this procedure - posterior dissection, anterior dissection and main bronchus and carina dissection. This video offers a comprehensive overview of the key anatomical landmarks that require identification during the procedure, the sequential steps involved and the critical pitfalls. Conclusion Thoracoscopic esophagectomy for esophageal cancer should be performed in high-volume centers, in a standardized and systematic way. Video revision and procedure debriefing is essential not only for surgery learning and coaching, but also for outcome improvement. Sharing knowledge and experience through video-based presentations can contribute to development of this complex area of minimally invasive esophagectomy. https://drive.google.com/file/d/1vWJOTCey8wI6HQi0jAR8C_t3tUKVbrW1/view?usp=drive_link