Single-port inflatable mediastinoscopy combined with laparoscopic esophagectomy via right cervical auxiliary operating port and sternal lifting: a safe and reliable surgical method.

Background: Minimally invasive esophagectomy (MIE) has revolutionized esophageal cancer treatment, but limitations in mediastinal exposure and lymph node dissection remain significant challenges. This study aimed to explore the application and safety of an improved surgical method combining single-port inflatable video-assisted mediastinoscopic transhiatal esophagectomy (SP-IVMTE) with a right cervical auxiliary operating port and sternal lifting.

Methods: This study reviewed data from 304 patients who underwent esophagectomy from January 2022 to June 2024. Patients were divided into 274 who underwent video-assisted MIE (VAMIE) and 30 who underwent SP-IVMTE. Propensity score matching (PSM) minimized selection bias, resulting in 120 VAMIE and 30 SP-IVMTE patients being analyzed. Surgical and postoperative data were collected.

Results: All SP-IVMTE surgeries were successfully completed without significant intraoperative injuries. The use of auxiliary ports and sternal lifting significantly increased operating space and improved the visual field, reducing the difficulty of subcarinal lymph node dissection. After PSM, there were no significant differences between the groups in terms of operation time, number of lymph nodes dissected, or postoperative hospital stay. The SP-IVMTE group required fewer fiber-optic bronchoscopy (FOB) suctions, indicating better postoperative recovery and safety.

Conclusions: The combination of auxiliary operating ports and sternal lifting in SP-IVMTE provides a safe and reliable surgical method, with enhanced operability and a stable surgical field, offering potential for widespread application in esophageal cancer patients.