Single lung ventilation via double-lumen endotracheal tube. Collapse right lung.
Right posterolateral thoracotomy through the fifth or sixth intercostal space.
Divide the azygous vein (if needed).
Incise the pleura and mobilize the esophagus.
Take care to avoid injury to the recurrent laryngeal nerves.
Close the chest with thoracostomy tube drainage.
Abdominal Dissection
Upper midline abdominal incision.
Divide the gastrocolic ligament, preserve the right gastroepiploic artery, and ligate the left gastroepiploic artery and short gastric arteries.
Dissect the lesser curvature via the lesser sac; preserve the right gastric and aberrant left hepatic artery if present.
Ligate the left gastric vessels.
Circumferentially free the esophagus at hiatus.
Perform a generous Kocher maneuver.
Gastric drainage procedure (pyloromyotomy or pyloroplasty) to prevent delayed emptying.
Feeding jejunostomy, if desired.
Close hiatus.
Cervical Dissection
Incision through the platysma.
Dissect anterior to the sternocleidomastoid.
Mobilize the esophagus.
Avoid traction injury or cautery injury to the recurrent laryngeal nerve.
Cervical anastomosis stapled/sutured.
Close wound with drainage.
Educational aid only. Verify every dose, indication, and guideline against current institutional protocol. This is not a substitute for clinical judgment.
