Introduction: Adenocarcinoma of lower esophagus and GEJ shows worldwide an increasing incidence. One of the major disadvantages of radical esophagectomy with extensive lymphadenectomy with open technique is its high rate of morbidity and mortality. Recent advances in minimally invasive surgical technology have allowed surgeons to apply this techniques for the treatment of Siewert I carcinoma. Moreover, the value of sentinel node navigation has been demonstrated by using the double tracer.

Methods: In the video we report the case of a 78 years-old man affected by Siewert I adenocarcinoma of GEJ who was submitted to Ivor Lewis esophagectomy by using laparoscopic abdominal approach and right thoracotomy. Four ports were used for the abdominal approach. During the operation we have identified the sentinel node by using the double tracer (99mTc tin colloid was injected the day before surgery by preoperative endoscopy and lymphoscintigraphy was performed prior to operation). During the laparoscopy, blue patent was intraoperatively injected using an endoscope. A complete mobilization of the stomach preserving the right gastroepiploic arcade was achieved. The patient was then turned to the left lateral decubitus position proned to 30 degrees. After then, the operation has been completed through a right thoracotomy.

Results: The post-operative course was uneventful.The pathology report demonstrated an R0 resection.

Conclusion: The application of minimally invasive techniques in the arena of esophageal surgery continues to evolve. This approach has the potential to improve the postoperative outcome when compared with open methods.