Esophagus replaced by minimally invasive surgery for the first time at Mainz University Medical Center

Innovative surgical procedure performed at only a few German hospitals


For the first time at the Mainz University Medical Center, physicians of the Department of General, Abdominal, and Transplantation Surgery have removed and replaced the esophagus of a patient suffering from esophageal cancer using a minimally invasive surgical technique. The patient is doing very well and was able to be discharged a few days after the procedure. A second such operation has also been successful in the meantime. The minimally invasive procedure is much more patient-friendly than the traditional 'open' surgical technique. Patients experience less pain, recover more rapidly from the intervention, and can leave the hospital sooner.

Barrett's carcinoma, the most common type of esophageal cancer, is considered to be a rare type of cancer in comparison with other forms. However, the number of cases has risen sharply in recent years. This means that in numerical terms, Barrett's carcinoma is the fastest-growing type of cancer in the Western world. Today, six times as many people develop Barrett's carcinoma in comparison with 30 years ago. Esophageal cancer is often detected late, because the symptoms, such as difficulty in swallowing, usually only occur in the advanced stage of the disease. Risk factors include frequent heartburn as well as smoking and excessive alcohol consumption.

Surgical intervention is often necessary to treat esophageal cancer. The standard 'open' version of this operation, which is one of the most major forms of intervention in tumor surgery, is performed as a so-called two-cavity procedure that requires incisions of up to 20 centimeters in the stomach and chest. In the minimally invasive version, in which a keyhole surgical technique is employed, the surgeon inserts the instruments needed via several small incisions in the abdomen that are no longer than one centimeter. Only the incision to actually remove the tumor is somewhat larger at three to four centimeters. "The minimally invasive version has several advantages for patients," explained PD Dr. Ines Gockel, senior physician at the Department of General, Abdominal, and Transplantation Surgery. "The surgical trauma and associated post-operative pain are less marked. Patients thus recover more rapidly and experience fewer complications so that the period of their hospitalization is reduced."

The surgical techniques employed during the minimally invasive surgical method are similar to those used during the 'open' version: As a first stage, a so-called gastric tube is formed. For this purpose, a portion of the stomach is converted into a tube that is designed to replace the diseased esophagus. The patient is then placed in a left lateral position so that the esophagus with the tumor can be removed from the thorax and the created gastric tube can be connected to the remaining upper portion of the esophagus. This complex surgery usually lasts several hours.

"The minimally invasive treatment of esophageal cancer places high demands on the entire treatment team, and we are very happy that we can offer this innovative procedure as one of the first hospitals in Germany," said Professor Hauke Lang, Director of the Department of General, Abdominal, and Transplantation Surgery. "In view of the major benefits to our patients, we will doubtless be establishing this method in Mainz as a standard part of our repertoire in future."