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Minimally Invasive Laparoscopic Procedures

By Costas Bizekis, M.D.

The NYU Division of Thoracic Surgery is proud to offer the latest techniques in minimally invasive surgery, including abdominal procedures used to treat various diseases of the esophagus.

Procedures performed using video-assisted equipment give our surgeons excellent visualization of the area in question and greatly enhance the accuracy and safety of the procedures. Our surgeons use smaller incisions, creating less discomfort and faster recoveries for our patients.

While less invasive methods are often the preferred treatment option for both patient and surgeon, certain cases do not benefit from the technique. Each case is reviewed on an individual basis to determine the best method of treatment.

Achalasia

Progressive difficulty in swallowing (dysphagia) can sometimes indicate this benign (non-cancerous) disease of the esophagus.

Achalasia is usually diagnosed with a barium esophagram. A gastroenterologist will also perform an endoscopy and a manometry test, which evaluates the ability of the esophagus to work as a muscle.

The procedure performed to correct achalasia requires an overnight hospital stay. Laparoscopic Heller myotomy and Dor fundoplication is performed through five incisions, all less than 1cm in size.

The day after surgery, an esophagram is performed to check the repair. A liquid diet must be started prior to discharge from the hospital.

GERD/Hiatal Hernia/Paraesophageal Hernia

Chronic heartburn can develop into gastroesophageal reflux disease (GERD), a progressive condition that causes worsening heartburn despite treatment with medications. GERD is usually caused when the muscular valve at the lower part of the esophagus (lower esophageal sphincter) becomes defective.

Sometimes there is also an associated hiatal hernia. A hiatal hernia occurs when a portion of the stomach slips up through an opening in the muscle that separates the chest from the abdomen (diaphragm). Chronic GERD can lead to Barrett's Esophagus, which is a precancerous condition.

The procedure to correct GERD is called a laparoscopic Nissen fundoplication and requires an overnight hospital stay.

Laparoscopic Nissen fundoplication uses a portion of the stomach to wrap the lower esophageal sphincter. This serves to reconstruct the muscular valve and prevent the reflux. If present, the hernia is also fixed at this time. The procedure is performed through five incisions, all less than 1cm in size.

The day after surgery, an esophagram is performed to check the repair. A liquid diet must be started prior to discharge from the hospital.

Esophagectomy

Esophagectomy is a common surgery for the treatment of esophageal cancer. The minimally invasive version of this surgery is done through small incisions in the abdomen, chest and lower neck.

During the esophagectomy all or part of the esophagus is removed, along with nearby lymph nodes and any surrounding tissue that has been compromised by cancer.

To replace the part of the esophagus that is removed, the stomach or part of the intestine is pulled up to connect to the remaining portion of the esophagus. This connection, the anastomosis, can be performed in either the neck or chest.