Robotic-Assisted Esophageal Mobilization for McKeown Esophagectomy

This video demonstrates robot-assisted esophageal mobilization as part of a McKeown esophagectomy for a 53-year-old patient with distal esophageal adenocarcinoma. Following neoadjuvant FLOT chemotherapy, the patient exhibited a favorable response, prompting surgical resection. 
 
The procedure began with port placement, targeting the esophagus at the level of the carina. Initial dissection involved mobilization of the inferior pulmonary ligament down to the pericardium, followed by lymphadenectomy, which included subcarinal (station 7), right paratracheal (stations 4R and 2R), and fluorodeoxyglucose-avid lymph nodes. Careful dissection along the azygous vein was performed, with division using a white load stapler while preserving the thoracic duct. The mesoesophagus was taken using a vessel sealer, and mobilization extended inferiorly to the diaphragmatic crus, ensuring avoidance of abdominal insufflation. A vessel loop was utilized for esophageal manipulation, facilitating en bloc mobilization. The procedure concluded with the placement of a smart drain through the anterior port. Key intraoperative considerations included minimizing thermal injury near the trachea, ensuring complete lymphadenectomy, and maintaining precise dissection planes. 
 
This video highlights critical technical steps, anatomical landmarks, and operative pearls essential for safe and effective robotic esophageal mobilization for a McKeown esophagectomy. 

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