Pursestring Stapled Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy

Abstract Background Total endoscopic Ivor-Lewis esophagectomy is a challenging, complex, and costly operation. These disadvantages restrict its wide application. The aim of this study was to compare the modified reverse-puncture anastomotic technique and traditional technique for total minimally invasive Ivor-Lewis esophagectomy. Methods In this cohort retrospective study, all patients with medial and lower squamous cell carcinoma of esophagus from February 2014 and June 2018 were divided into two groups according to the surgical method, which were modified reverse-puncture anastomotic technique group and traditional technique group. The operation time, intraoperative bleeding volume, complications, and cost of the two groups were compared. Results Forty-eight patients in the modified reverse-puncture anastomotic technique group while 54 patients in the traditional technique group were included. The operation time was 293.4 ± 57.2 min in the modified reverse-puncture anastomotic technique group, which was significantly shorter than that in the traditional technique group (353.4 ± 64.1 min) (P < 0.05). The intraoperative bleeding volume of modified reverse-puncture anastomotic technique group was 157.3 ± 107.4 ml, while it was 191.9 ± 123.6 ml in traditional technique group (P = 0.14). There were similar complications between the two groups. The cost of modified reverse-puncture anastomotic and traditional technique in our hospital were and 72 ± 13 and 83 ± 41 thousand Yuan, respectively (P = 0.08). Conclusion The good short-term outcomes that were achieved suggested that the use of modified reverse-puncture anastomotic technique is safe and feasible for total endoscopic Ivor-Lewis esophagectomy.

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Reverse-Puncture Anastomotic Technique for Minimally Invasive Ivor-Lewis Esophagectomy

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2015.04.140 ◽

2015 ◽

Vol 100 (6) ◽

pp. 2372-2375 ◽

Cited By ~ 8

Author(s):

Ping Xiao ◽

Xiang Zhuang ◽

Yi Shen ◽

Qiang Li ◽

Wei Dai ◽

...

Keyword(s):

Minimally Invasive ◽

Ivor Lewis ◽

Anastomotic Technique ◽

Ivor Lewis Esophagectomy

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Using the Hand-Sewn Purse-String Stapled Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1660848 ◽

2018 ◽

Vol 67 (07) ◽

pp. 578-584 ◽

Cited By ~ 1

Author(s):

Bicheng Zhan ◽

Jian Chen ◽

Shaoming Du ◽

Yanzheng Xiong ◽

Jian Liu

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Anastomotic Stricture ◽

Circular Stapler ◽

Fixation Time ◽

Purse String ◽

Ivor Lewis ◽

Anastomotic Technique ◽

Open Esophagectomy ◽

Ivor Lewis Esophagectomy

Background Minimally invasive Ivor Lewis esophagectomy (MIILE) is increasingly being used in the treatment of middle or lower esophageal cancer. Hand-sewn purse-string stapled anastomosis is a classic approach in open esophagectomy. However, this procedure is technically difficult under thoracoscopy. The hardest part is delivering the anvil into the esophageal stump. Herein, we report an approach to performing this step under thoracoscopy. Methods A total of 257 consecutive patients who underwent MIILE between April 2013 and July 2017 were analyzed retrospectively. The operator hand sewed the purse string using silk thread under thoracoscopy, and the 25-mm circular stapler was passed through the anterior axillary line at the fourth intercostal space to finish the side-to-end gastroesophageal anastomosis. Patient demographics, intraoperative data, postoperative complications were evaluated. Results The mean operative time, thoracoscopy time, and anvil fixation time was 307.0 ± 34.3, 155.4 ± 21.5, and 7.1 ± 1.6 minute, respectively. The anastomotic leak and anastomotic stricture occurred in 6.6% (17 of 257) and 3.9% (10 of 257) of patients, respectively. There was no intraoperative death; one case was death of acute respiratory distress syndrome (ARDS) for conduit gastric leakage on the 21st postoperative day. Conclusion Using the hand-sewn purse-string stapled anastomotic technique for MIILE is feasible and relatively safe in patients with middle or lower esophageal cancer.

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T-shaped linear-stapled intrathoracic esophagogastric anastomosis for minimally invasive Ivor Lewis esophagectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.137 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 137-137

Author(s):

YiNan Dong

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Posterior Wall ◽

New Technique ◽

Linear Stapler ◽

Anastomotic Site ◽

Ivor Lewis ◽

Anastomotic Technique ◽

Ivor Lewis Esophagectomy ◽

Anastomotic Bleeding

137 Background: Linear stapler is increasingly used for the gastroesophageal anastomosis in minimally invasive esophageal cancer surgeries; however, it is more commonly used in cervical delta anastomosis, less in totally thoracoscopic Ivor Lewis esophagectomy for esophageal cancer. A standardized rapid linear stapler based gastroesophageal anastomotic technique remains to be developed. Methods: Here we report a new technique for the endoscopic gastroesophageal anastomosis that is completed just with a linear stapler (Ethicon Flex 60). In this technique, a linear stapler is first fired upward to establish the side to side anastomosis of the esophagus and stomach. This creates the anterior and posterior wall of the anastomotic site. The linear stapler is then fired along the extension line of the gastric conduit, to complete the anastomosis and at the same time resect the lesser curvature of the stomach and the esophageal cancer. Upon completion, the anastomotic plane is axial, and contains a superior edge, inferior edge, and anterior edge. Results: By the middle of September 2015, we have performed the minimally invasive Ivor Lewis esophagectomy with this anastomosis for 26 esophageal cancer patients. We are following these patients, and the longest follow up time is about 18 month and the shortest is 12 month. None of these patients has had any anastomotic bleeding, leak, or stenosis. Conclusions: This new technique is less restricted by the limited space during minimally invasive Ivor Lewis procedure. The anastomotic technique is easy to perform and appears to be reliable, safe and effective judging from our limited clinical experience up to this date.

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Indocyanine green perfusion assessment of the gastric conduit in minimally invasive Ivor Lewis esophagectomy

Surgical Endoscopy ◽

10.1007/s00464-021-08346-9 ◽

2021 ◽

Author(s):

Keouna Pather ◽

Adeline M. Deladisma ◽

Christina Guerrier ◽

Isaac R. Kriley ◽

Ziad T. Awad

Keyword(s):

Minimally Invasive ◽

Indocyanine Green ◽

Gastric Conduit ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Perfusion Assessment

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792 OUTCOMES AFTER TOTALLY MINIMALLY INVASIVE VERSUS HYBRID OR OPEN IVOR LEWIS ESOPHAGECTOMY: RESULTS FROM THE INTERNATIONAL ESODATA STUDY GROUP.

Diseases of the Esophagus ◽

10.1093/dote/doab052.792 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Berend Van Der Wilk ◽

Eliza R C Hagens ◽

Ben M Eyck ◽

Suzanne S Gisbertz ◽

Richard Hillegersberg ◽

...

Keyword(s):

Length Of Stay ◽

Minimally Invasive ◽

Anastomotic Leakage ◽

Hospital Length Of Stay ◽

Mortality Data ◽

Study Group ◽

Ivor Lewis ◽

Open Esophagectomy ◽

Ivor Lewis Esophagectomy ◽

The Impact

Abstract To compare complications following totally minimally invasive (TMIE), laparoscopically assisted (hybrid) and open Ivor Lewis esophagectomy in patients with esophageal cancer. Three randomized trials have reported benefits for minimally invasive esophagectomy. Two studies compared TMIE versus open esophagectomy and another compared hybrid versus open Ivor Lewis esophagectomy. Only small retrospective studies compared TMIE with hybrid Ivor Lewis esophagectomy. Methods Data were used from the International Esodata Study Group assessing patients undergoing TMIE, hybrid or open Ivor Lewis esophagectomy. Primary outcome was pneumonia, secondary outcomes included incidence and severity of anastomotic leakage, (major) complications, length of stay, escalation of care and 90-day mortality. Data were analyzed using multivariate multilevel models. Results In total, 4733 patients were included in this study (TMIE:1472, hybrid:1364 and open:1897). Patients undergoing TMIE had lower incidence of pneumonia compared to hybrid (10.9% vs 16.3%, Odds Ratio (OR):0.56, 95%CI: 0.40–0.80) and open esophagectomy (10.9% vs 17.4%, OR:0.60, 95%CI: 0.42–0.84) and had shorter length of stay (median 10 days (IQR 8–16)) compared to hybrid (14 (11–19), p = 0.041) and open esophagectomy (11 (9–16), p = 0.027). Patients undergoing TMIE had higher rate of anastomotic leakage compared to hybrid (15.1% vs 10.7%, OR:1.47, 95%CI: 1.01–2.13) and open esophagectomy (7.3%, OR:1.73, 95%CI: 1.26–2.38). No differences were reported between hybrid and open esophagectomy. Conclusion Compared to hybrid and open Ivor Lewis esophagectomy, TMIE resulted in a lower pneumonia rate, a shorter hospital length of stay but a higher anastomotic leakage rate. The impact of these individual complications on survival and long-term quality of life should be further investigated.

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Modified Intrathoracic Esophagogastrostomy with Minimally Invasive Robot-Assisted Ivor-Lewis Esophagectomy for Cancer

Digestive Surgery ◽

10.1159/000495361 ◽

2018 ◽

Vol 36 (3) ◽

pp. 218-225 ◽

Cited By ~ 2

Author(s):

Wen-Ping Wang ◽

Long-Qi Chen ◽

Han-Lu Zhang ◽

Yu-Shang Yang ◽

Song-Lin He ◽

...

Keyword(s):

Minimally Invasive ◽

Circular Stapler ◽

Purse String Suture ◽

Robot Assisted ◽

Purse String ◽

Ivor Lewis ◽

Intrathoracic Anastomosis ◽

Ivor Lewis Esophagectomy ◽

Estimated Blood Loss ◽

Esophagectomy For Cancer

Background: Intrathoracic esophagogastrostomy plays an important role in minimally invasive Ivor-Lewis esophagectomy for cancer. Intrathoracic anastomosis with robot-assisted Ivor-Lewis esophagectomy (RAILE) includes hand-sewn and circular stapler methods, which remain technically challenging. In this study, we modified the techniques for intrathoracic anastomosis at RAILE, in order to simplify the complex procedures. Methods: “Side-insertion” technique was used for anvil placement and purse string suture for intrathoracic anastomosis at RAILE. Medical records for consecutive patients who had undergone robot-assisted minimally invasive Ivor-Lewis esophagectomy for cancer between January 2015 and June 2018 were analyzed. Results: A total of consecutive 31 patients were enrolled. There was no conversion to open thoracotomy in this cohort. Mean operation duration in the robotic group was 387.4 ± 68.2 min. Median estimated blood loss was 110 mL (range 50–400 mL). Two patients (6.5%) had postoperative anastomotic leak. No postoperative reoperation was needed and there were no mortality. Six patients (19.4%) had anastomotic stricture and 2 patients of them needed endoscopic dilation. Conclusion: RAILE is safe and feasible. Our modified procedure highlighting the “side-insertion” method may simplify the process of intrathoracic anvil placement and purse string suture for anastomosis at RAILE.

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