Transhiatal esophagectomy
Anesthesia type General
Airway 8-O ETT
Lines and access Large bore PIV

Arterial Line

Monitors Standard Arterial Line
Primary anesthetic considerations
Postoperative Anastamotic leak

The transhiatal approach is used with a laparotomy below the xiphisternum to mobilize the stomach and create an esophageal conduit from the greater curvature of the stomach. This conduit is brought up to the neck for a gastroesophageal anastamosis at the level of a neck incision.[1] With advances in laparoscopic and robotic surgical techniques, the transhiatal esophagestomy has been increasing in popularity once again.

Preoperative management

Patient evaluation

System Considerations

Labs and studies

Operating room setup

  • 8-O ETT for periemergence bronchoscopy
  • Arterial line
  • Large bore peripheral IV
  • NG tube to decompress stomach

Patient preparation and premedication

  • EKG leads on back of shoulders to facilitate neck prep

Regional and neuraxial techniques

  • Epidural for post-operative pain control

Intraoperative management

Monitoring and access

  • Standard ASA Monitors
  • Arterial line

Induction and airway management


  • Supine with both arms tucked

Maintenance and surgical considerations

Abdominal laparoscopy:
Gastric conduit creation:
Esophageal transection:
Gastric pull-through:
  • Watch peak and plateau pressures for signs of pneumothorax
  • Compression of RA may cause sudden hypotension
  • Avoid excessive vasopressors to uphold integrity of anastamosis site


Postoperative management


Pain management

Potential complications

  • Vocal cord palsy
  • Anastamotic leak
  • General pulmonary failure/complications

Procedure variants

  • Very few series have been published comparing robotic and laparoscopic approach.
Laparoscopic Robotic
Unique considerations
Position Supine Supine; arms tucked
Surgical time 279min[2] 267-311min
EBL 88mL[2] 54-100mL
Postoperative disposition
Pain management Epidural
Potential complications Pulmonary

Anastamotic leak (9-33%)

Vocal cord palsy (5-30%)

Length of Stay 9.2 days[2] 9-10 days


  1. Nottingham, James M.; McKeown, David G. (2021), "Transhiatal Esophagectomy", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32644622, retrieved 2021-06-17
  2. 2.0 2.1 2.2 Seto, Yasuyuki; Mori, Kazuhiko; Aikou, Susumu (2017-09). "Robotic surgery for esophageal cancer: Merits and demerits". Annals of Gastroenterological Surgery. 1 (3): 193–198. doi:10.1002/ags3.12028. ISSN 2475-0328. PMC 5881348. PMID 29863149. Check date values in: |date= (help)