Try not to dissect the azygos vein too close to the chest wall as a stump of 2–3cm may provide better traction in the following steps. Alternatively, a hand­held vascular stapler can be used. Once this step has been completed, the right paratracheal lymph nodes can be dissected separately. The next step is to dissect the pleura down to the esophageal hiatus. The plane should be extended parallel to the azygos vein. The thoracic duct should be visualized and dissected at the lower mediastinum (Fig.14.8).

the dissection of the specimen at the level of the azygos vein can be performed. The esophageal wall can be opened using monopolar scissors or hooks. After complet­ing a purse string suture of the proximal end, externalize both suture ends via T5. Secure the distal esophageal opening through T5 with a grasper. Attempt to ascend the conduit into the thoracic cavity using gentle traction, maintaining contact with the vessel end at all times. At this point, we will describe the end-to-side circular anastomotic technique used in our clinic. As there is still no consensus on the ideal anastomotic type for intrathoracic reconstruction, alternative anastomotic types such as a linear stapled or hand-sewn anastomosis can be used. The robotic instru­ments are retrieved and the trocars are undocked. T5 is removed and a mini­thoracotomy is performed 2–3cm anterior and 2cm posterior to the epicenter of T5. A wound protector is placed and the 25 or 28 mm anvil (CEEATM, Covidien, Manseld, MA, USA) is passed through the mini-thoracotomy to the proximal end of the esophagus, and the purse string is tightened. The specimen is then external­ized through the mini-thoracotomy and the right angulation of the conduit is checked (the stapler line along the lesser curvature should be opposite to the aorta). The specimen is then partially externalized, a small incision is made at the end of the lesser curvature at the stapler line, and the stapler shaft is inserted through the inci­sion and brought into the thoracic cavity. The shaft pin of the stapler is exteriorized cranially near the greater curvature of the gastric conduit. The shaft and anvil are approximated under continuous visualization. Using a hand-held grasper through T2, the fatty tissue of the greater omentum is removed from the anastomotic fronts to avoid stapling this tissue into the anastomosis. The anastomosis is created and the stapler removed. The specimen is divided using a linear stapler (Fig.14.11). Single interrupted monolament sutures may be used to secure the anastomosis (alterna­tively a continuous barbed resorbable suture may be used). A pleural tent and the use of a 180–270° omental ap can be further created around the anastomosis. The trocars are removed and a chest tube is inserted through T1. Once the lung is fully expanded, the mini-thoracotomy and wound are closed.

The lymph nodes of the RLN are dissected. The parietal pleura should be incised parallel to the right vagus nerve extending towards the right subclavian artery. This is the recurrent point for the right RLN.These lymph nodes should be dissected separately from the specimen.

After creating the anastomosis in the cervical region (see below), the stomach should be retracted in the abdomen for a few centimeters and the pylorus should be close to the hiatus. This is the end of the abdominal phase.

It is clear that the cervical phase will begin before the end of the abdominal phase, and this step can be also performed by a second surgical team. An incision parallel and median to the medial border of the left sternocleidomastoid muscle (approximately 4cm) should start from the jugulum and extend cranially. After dis­secting the platysma, the dissection follows the layers to the thoracic inlet. At this point, the cervical esophagus should be identied. A loop may be used to encircle the esophagus for better traction. Once the cervical esophagus has been mobilized, the specimen and conduit can be advanced to the neck. The cervical esophagus is dissected and the specimen is retrieved. We perform a circular-stapled anastomosis, but other techniques can be used for reconstruction (linear or hand-sewn anastomo­sis). The anastomosis can be further secured with interrupted absorbable