En Block Resection of Heart and Lung and Esophagus

Novel techniques for en bloc lung and esophagus harvest have introduced refined dissection planes, improved vascular control, and enhanced preservation of mediastinal integrity compared to classic stepwise procurement methods. By mobilizing the esophagus and lungs together within a single continuous anatomical package, these approaches reduce traction injury, limit devascularization of segmental blood supply, and ensure more precise preservation of the vagus nerves, bronchial arteries, and periesophageal lymphatics. The en bloc strategy also minimizes instrument exchanges and reduces operative time, while providing a more anatomically sound graft for complex reconstructions such as lung–esophageal composite transplantation or esophageal replacement after pneumonectomy. In contrast to traditional isolation of each structure, en bloc harvest maintains natural anatomical relationships, reduces tissue trauma, and enhances graft viability - ultimately improving post-transplant healing, reducing leak or stenosis rates, and supporting more physiologic respiratory and gastrointestinal function.