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Showing the axial CT scan demonstrating the narrowed oesophageal lumen encircled in yellow.
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On the island, there is no facility for endoscopic ultrasound, and as such, a staging contrast CT showed a stage 3 oesophageal tumour with no significant lymphadenopathy (Fig. 1).
Showing port placements during the thorascopic stage.
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During phase one, a right thorascopic approach was initially used, with the patient in a prone position (Fig. 2).
Showing oesophageal dissection and mobilization.
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In order to better visualise the oesophagus, an artificial pneumothorax at 8 mmHg pressure was created, and the oesophagus was mobilised away from the mediastinum on the right (Fig. 3).
Showing the formation of the gastric conduit.
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A D1 lymphadenectomy was performed, the left gastric vessels were taken with Covidien vascular staple, with preservation of the right gastric and the right gastroepiploic vessels, and the gastric conduit was fashioned (Fig. 4).
The final specimen.
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In the third stage, the cervical stage, the oesophagus was mobilised and transected, a nasogastric tube attached to the distal oesophagus, and the specimen removed through the umbilical incision (Fig. 5).