Introduction: Iatrogenic esophageal perforation associated with esophageal carcinoma is a complex scenario associated with significant morbidity and mortality. Treatment options include conservative management with radiologic drainage, use of esophageal stents, or even esophagectomy if diagnosed early. Esophagectomy is often reserved as the last treatment option because of its associated high mortality in the emergent setting. This video depicts a minimally invasive emergent esophagectomy performed for a patient with perforated and obstructed esophageal adenocarcinoma whereby the option for endoscopic stenting is not feasible.

Methods: Laparoscopy with 5 abdominal ports was performed to mobilize the stomach, preserving the right gastroepiploic vessels, and to dissect around the esophageal hiatus. A gastric conduit was constructed using the linear stapler and attached to the surgical specimen with sutures at 4 points. Thoracoscopy with 4 ports was then used to complete the esophageal mobilization and the peri-esophageal abscess was drained. The gastric conduit was pulled up into the right chest. The linear stapler was used to transect the proximal noninflamed esophagus. An esophago-gastric anastomosis was then created using a circular stapler.

Results: The intra-abdominal operative time was 1.5 hours and the intra-thoracic time was 1.25 hrs with an estimated blood loss of 100cc. UGI study was negative for leak on post-operative day 6. Chest tube was removed on post-operative day 7. The length of hospital stay was 13 days. There were no post-operative complications.

Conclusion: Minimally invasive esophagectomy in the emergent setting is a safe alternative for management of esophageal perforation in select cases.