Prone approach for minimally invasive esophagectomy: history and surgical approach

Esophagectomy has traditionally been a procedure wrought with significant morbidity. The advent of minimally invasive esophagectomy (MIE) has led to significant changes in outcomes. Starting originally as a hybrid open procedure, now most MIEs are done entirely via a laparoscopic and thoracoscopic approach with a neck approach if performing a cervical anastomosis. Using a completely minimally invasive approach has led to a decrease in postoperative morbidity as well as reduced wound and cardiopulmonary complications. Initially, the esophageal mobilization was performed via a left lateral decubitus approach. Later, the thoracic portion of the procedure was performed via a prone approach. The prone approach can aid in both visualization during surgery as well as decreased blood loss, improved lymph node harvest, decreased cardiopulmonary complications with no differences in morbidity and mortality.