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Parthasarathi et al. Mini-invasive Surg 2019;3:20 I http://dx.doi.org/10.20517/2574-1225.2019.10 Page 7 of 14

Figure 8. Exposure after retraction of the divided azygous vein

Figure 9. Subcarinal lymph node dissection

conduit to be visualized and pulled up to check for adequacy of the length of the conduit. Mediastinal
pleura incised, Azygous vein is skeletonized at the level of the azygous arch, Azygous vein is doubly ligated
with silk no two sutures, and one suture towards the vertebral end is left long to help in retraction of the
vein during dissection of aortopulmonary window [Figure 8]. The esophagus is mobilized proximally till
the subcarinal level (usually 5-6 cm above the transected end to achieve adequate proximal margin), and
nodal lymph dissection is done [Figure 9]. We perform standard two-field lymphadenectomy; thoracic duct
is not excised in all the cases, except in cases where the patient weight is below 35 kg.

Proximally with adequate clearance esophagus is divided using endo GIA stapler. After proximal
esophageal division, four full-thickness (adventitia to the mucosa) sutures are placed anteriorly
on both the sides and posteriorly to prevent esophageal mucosal retraction [Figure 10]. The gastric
conduit is pulled closer, and the esophagogastric anastomosis is performed [Figure 11].

Esophagogastric anastomosis: This is accomplished in three ways: (1) End to end/side hand-sewn
anastomosis; (2) End to side fully mechanical anastomosis-circular stapler; (3) Side to side fully mechanical
anastomosis-linear cutter stapler. End to end/side hand-sewn anastomosis: The two ends are approximated