Yi Zhang - Atlas of Thoracoscopic-lapacoscopic Esophagectomy

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Qizhou Bo (Corresponding author)

Tiecheng Pan

In 1910, Jacobaeus described a surgical procedure named thorakoskopie, and from then on, he was considered the first doctor to embark on thoracoscopy. This word, however, had already been well-known in France long before Jacobaeus; the 15-volume The Grand Dictionnaire Universel published in 1876 used the word Thoracoscopic consisting of the Greek words thorax and skopia (visual examination). Volume 16 published in 1878 defined the thoracoscope as Instrument pourobserver les alt rations des voies respiratories et da la poitrine, i.e., an instrument for respiratory tract and lung changes. In 1866, Samuel Gordon described the process wherein F. R. Cruise used an endoscope to treat an 11-year-old girl (Fig. ) in his Clinical Reports of Rare Cases, Occurring in the Whitworth and Hardwicke Hospitals published in the Dublin Quarterly Journal of Medical Science . On April 27, 1866, an 11-year-old girl was admitted into the Whitworth Hospital for a 2-month history of cough and left chest pain, in which upon physical examination she was found weak, with short breaths (68/min) and tachycardia (140/min), and her left thoracic cavity was found with a great volume of effusion upon thorough examinations. On April 29, 1866, the girl was given parasternal puncture aspiration between the left third and fourth ribs and yellowish-green serous fluid discharged. Air escaped into the left thoracic cavity even if the puncture was made very carefully. The girl received a second puncture to drain the pus on May 2, 1866, as her condition deteriorated; after that, she was equipped with a drainage device which accompanied her over the long period of rehabilitation. In July 1866, the girl was healed according to the normalized breathing movements of the left chest and improved heart displacement even though purulent discharges did not disappear. After the drain tube was removed on January 13, 1867, pus kept flowing out of the fistula. At the end of the article, Gordon stated that Cruise repeatedly inserted an endoscope into the thoracic cavity through the fistula opening, and this is the first chest examination in the history of endoscopy. Gordon stressed that the purpose of the endoscopy is to check the results of treatment by regular examination of the pleura and the inner face of the thoracic cavity. This article reported examinations by thoracoscopy about 50 years before Jacobaeus. The fact that it takes five decades to popularize this technique may be attributed to peoples insufficient knowledge of the thoracic cavity and respiratory physiology and to the shortage of surgical instruments.

Desormeaux used the term endoscope for the first time in 1853 at the Medical Academy in Paris. Cruise successfully used this set in cystoscopy and other examinations. After that, the Serafimerlasarettet Hospital of Sweden and Professor Jacobaeus of Stockholm University used a modified cystoscope to separate adhesions in the treatment of pulmonary tuberculosis using artificial pneumothorax; this is the first thoracoscopic operation in the world and was then called thorakoskopie. In his first paper published in Munich , Germany, in 1910, Jacobaeus called the process in which the patient is examined with a cystoscope inserted into the peritoneal cavity as laparoskopie. Despite the incidence of severe complications, this technique swept over the world, with more than 1000 cases reported. Jacobaeus published his second paper in Archives of Radiology and Electrotherapy , USA, in 1932. Before long, it fell into disuse since the invention of streptomycin in 1945 and only served as a secondary diagnostic option in limited medical centers of Europe.

Kurt Semm of the Kiel School of Gynaecological Endoscopy invented an apparatus for the automatic insufflation of gas in 1963 and a heat conducting system for thermocoagulation in 1973. In 1980, Semm performed the first laparoscopic appendectomy, and the German Erich Mhe performed the first laparoscopic cholecystectomy with Semms apparatuses on September 12, 1985. This is the beginning of the application of laparoscopy to general surgery. This technique was then used in chest surgery and significantly stimulated the development of minimally invasive surgery of the chest with the advancement of optical technologies, video-assisted device, apparatuses, and surgical consumables; before long the minimally invasive surgery technique was introduced to esophageal cancer surgery.

To begin with, it should be made clear that thoracoscopic-laparoscopic esophagectomy (TLE), as a surgical procedure, is only a type of minimally invasive esophagectomy (MIE).

For a lower mortality of esophagectomy, surgeons began to use minimally invasive techniques for esophageal resection mainly in the thoracoscopic esophageal mobilization combined with standard open transabdominal total esophagectomy and then introduced total laparoscopic minimally invasive techniques to transhiatal esophagectomy with cervical esophagogastrostomy. But it did not support standard lymph node dissection with a series of problems, such as a limited field of vision and difficulties in reaching the mediastinum by the transhiatal route. These problems pushed pioneer surgeons toward the minimally invasive thoracoscopic-laparoscopic esophagectomy, which became a trend for its availability for complete esophageal mobilization and lymph node dissection.