Editing Oesophagectomy (section)

== '''Left sided Ivor Lewis approach:''' ==

* Right lateral position, with     left hip rolled slightly back to facilitate abdominal exposure
* Posterolateral thoracotomy     through 6th intercostal space, extended across the costal margin into the     abdomen, and peripheral phrenotomy (leaving a peripheral rim of 2cm of     diaphragm on the chest wall to permit closure)
**
* Oesophagus mobilised from     aortic arch down to hiatus
** Pericardium can be resected      en bloc if needed
** Spleen and tail of pancreas      mobilised, to expose the LUQ widely
* Greater curvature mobilised     fully to the level of the pylorus, gastrohepatic ligament divded, right     gastric vessels divided, left gastric vessels divided, gastric tube     fashioned
* Abdominal lymph node     dissection (D11)
** Splenic hilum back down to      left gastric artery stump
** Common hepatic nodes up to      IVC and PV
** Coeliac axis nodes
* Back to chest for anastomosis
** Usually between inferior      pulmonary vein and aortic arch
** Free thoracic oesophagus      from behind the aortic arch using blunt dissection, after incising the      pleural above the arch (watch for the recurrent nerve)
* Thoracic lymph node     dissection completed
* Transect oesophagus