Thoracoscopic repair of Boerhaave's syndrome in the prone position: A novel left-sided minimally invasive approach.

Boerhaave's syndrome, a spontaneous transmural rupture of the esophagus, is associated with high mortality and requires left thoracotomy. Minimally invasive surgery (MIS) is an alternative. Although most reports on thoracoscopic repair describe the procedure being performed in the lateral decubitus position, there are few reports of repairs conducted in the prone position. We hereby describe a left-sided thoracoscopic technique for primary esophageal repair, in the prone position. Patients are positioned prone and procedure is conducted under general anesthesia with carbon dioxide pneumothorax, avoiding one-lung ventilation. The esophageal muscular layer is incised for complete visualization of the mucosal defect after exposing the lower esophagus. The rupture is closed with layer-to-layer sutures. The procedure is performed with adequate mediastinal and pleural drainage. The technique was performed on two patients with surgical times of 143 and 208 min, and both patients had uneventful recovery. In the prone position, this procedure offers excellent exposure of the lower mediastinum and might reduce pulmonary burden. This approach appears safe in selected stable patients.