Laparoscopic intracorporeal stapling of the gastric tube on the basis of surface blood supply after minimally invasive esophagectomy

Abstract Purpose: This retrospective study evaluated the impact of nasogastric decompression (NGD) on gastric tube size to optimize the Enhanced Recovery After Surgery protocol after McKeown minimally invasive esophagectomy (MIE). Methods: Overall, 640 patients were divided into two groups according to nasogastric tube (NGT) placement intraoperatively. Using propensity score matching, 203 pairs of individuals were identified for gastric tube size comparisons on postoperative days (PODs) 1 and 5. Results: Gastric tubes were larger in the non-NGD group than the NGD group on POD 1 (vertical distance from the right edge of the gastric tube to the right edge of the thoracic vertebra, 22.2 [0–34.7] vs. 0 [0–22.5] mm, p <0.001). No difference was noted between the groups on POD 5 (18.5 [0–31.7] vs. 18.0 [0–25.4] mm, p =0.070). Univariate and multivariate analyses showed that non-NGD was an independent risk factor for gastric tube distention on POD 1. No difference in the incidence of complications (Clavien–Dindo（CD）≥2) (40 (23.0%) vs. 46 (19,8%), p =0.440), pneumonia (CD≥2) (29 [16.8%] vs. 30 [12.9%], p =0.280) or anastomotic leakage (CD≥3) (3 [1.7%] vs. 6 [2.6%], p =0.738) were noted between the without gastric tube distention group and with gastric tube distention group. Conclusion: Intraoperative NGT placement reduces gastric tube distention rates after McKeown MIE on POD 1, but the complications are similar to those of unconventional NGT placement. This finding is based on NGT placement or replacement at the appropriate time postoperatively through bedside chest X-ray examination.

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Laser Doppler Flowmetry and Visible Light Spectroscopy of the Gastric Tube During Minimally Invasive Esophagectomy

Vascular Health and Risk Management ◽

10.2147/vhrm.s269138 ◽

2020 ◽

Vol Volume 16 ◽

pp. 497-505

Author(s):

Nathkai Safi ◽

Hans-Olaf Johannessen ◽

Asle Wilhelm Medhus ◽

Tom Mala ◽

Syed SH Kazmi

Keyword(s):

Minimally Invasive ◽

Visible Light ◽

Laser Doppler Flowmetry ◽

Gastric Tube ◽

Minimally Invasive Esophagectomy ◽

Laser Doppler ◽

Doppler Flowmetry ◽

Invasive Esophagectomy ◽

Visible Light Spectroscopy

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RA04.07: A NOVEL TECHNIQUE FOR CERVICAL GASTROESOPHAGEAL ANASTOMOSIS DURING MINIMALLY INVASIVE ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra04.07 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 26-26

Author(s):

Yuequan Jiang

Keyword(s):

Minimally Invasive ◽

Anastomotic Leakage ◽

Gastric Tube ◽

Minimally Invasive Esophagectomy ◽

Occurrence Rate ◽

Controlled Study ◽

Cervical Anastomosis ◽

Anastomotic Technique ◽

Invasive Esophagectomy ◽

Postoperative Leakage

Abstract Background Anastomotic leakage, fibrous stricture and gastroesophageal reflux are three major complications of gastroesophageal anastomosis, particularly in cervical anastomosis. Our aim was to evaluate the safety and efficacy of a novel cervical anastomosis technique (NA) by comparing it to the traditional side-to-side anastomosis (SS), and the end-to-side anastomosis using a circular stapler (CS) in terms of postoperative leakage, stricture and reflux. Methods A total of 390 patients with thoracic esophageal cancer underwent a minimally invasive esophagectomy with cervical anastomosis (192 with NA, 34 with SS and 164 with CS) in our institute from January 2013 and May 2016. The new anastomotic technique was improved from a type of side-to-side anastomosis technique which was reported by Collard et al. The difference of our new technique is that the part of the anastomotic stump was pushed into the tubular stomach. It let the end part of esophagus was embedded in the gastric tube while the end portion of the stomach was also reversed into the gastric tube (figure 1, 2, 3). The major postoperative complications including postoperative leakage, stricture and reflux were compared using three armed controlled study. Results With regard to the incidence of anastomotic leakage and reflux, the patients who underwent Jiang's anastomosis had a significantly lower rate than those in the SS group and CS group (Leaks: 1.0% vs. 8.8% and 8.5%, P = 0.025, 0.001; Reflux: 5.7% vs. 23.5% and 18.3%, P = 0.003, 0.001). The incidence of dysphagia was 10.4% with an occurrence rate of 1.5% for anastomotic strictures in the NA group. It was significant lower than that in the CS group (41.5% vs. 18.9%, P < 0.05) but not significantly different from that in SS group (11.8% vs. 2.9%). Conclusion The novel anastomotic technique remarkably reduced the incidence of gastroesophageal-anastomotic leakage, stricture and reflux and was a safe and effective technique for minimally invasive esophagectomy. Disclosure All authors have declared no conflicts of interest.

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VS03.08: ANASTOMOTIC TECHNIQUES FOR MINIMALLY INVASIVE TRANSTHORACIC ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.vs03.08 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 49-49

Author(s):

Daniele Bernardi ◽

Emanuele Asti ◽

Luigi Bonavina

Keyword(s):

Minimally Invasive ◽

Gastric Tube ◽

Conflicts Of Interest ◽

Minimally Invasive Esophagectomy ◽

Circular Stapler ◽

Linear Stapler ◽

Invasive Esophagectomy ◽

Orotracheal Tube ◽

Wound Retractor ◽

Mini Thoracotomy

Abstract Description Minimally invasive esophagectomy has the potential to reduce the incidence of pulmonary complications and postoperative pain. This video shows two safe and reproducible technical variants for thoracoscopic stapled anastomosis. The patient is placed in a left semi-prone position after induction of anesthesia with a single lumen orotracheal tube. Triportal access and low-pressure pneumothorax (8 mmHg) are used for the procedure. Once circumferential mobilization of the esophagus is completed, intraoperative ultrasonography is performed to identify a previously placed endoscopic metal clip marking the upper tumor level. The esophagus is safely transected above this level. An end-to-side intra-corporeal esophagogastric anastomosis is performed. Technique A. The esophagus is stapled with a 60 mm cartridge (EndoGIA™ Tri-Staple™ purple). The anvil of a 25 mm circular stapler (OrVil™) is inserted transorally and retrieved through a small hole in the esophageal stump. Technique B. The 25 mm anvil is inserted through a transverse esophagotomy with a 7 cm long 2–0 polypropylene suture attached to the sharp tip. The suture is passed from inside to outside of the esophageal lumen. The esophagus is then divided distal to the anvil with an linear stapler. At this point, the anvil is pulled out with a gentle traction close to the stapled line. In both techniques, the circular stapler is introduced into the chest cavity through a mini-thoracotomy at the level of lowermost trocar and a wound retractor (Alexis™) is used. The head of the circular stapler, sealed with a surgical glove cutted at the middle finger, is then introduced into the gastric tube through a small gastrotomy on the lesser curvature. The tip of the gastric tube is perforated close to the greater curvature and engage the esophageal anvil. After checking the doughnut, transection of the remnant gastric tube is completed with a linear stapler and the specimen is retrieved through the mini-thoracotomy. Disclosure All authors have declared no conflicts of interest.

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Faculty Opinions recommendation of The impact of tidal volume on pulmonary complications following minimally invasive esophagectomy: a randomized and controlled study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718095813.793484608 ◽

2013 ◽

Author(s):

Andreas Hoeft

Keyword(s):

Minimally Invasive ◽

Tidal Volume ◽

Minimally Invasive Esophagectomy ◽

Pulmonary Complications ◽

Controlled Study ◽

Invasive Esophagectomy ◽

The Impact

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European consensus on essential steps of Minimally Invasive Ivor Lewis and McKeown Esophagectomy through Delphi methodology

Surgical Endoscopy ◽

10.1007/s00464-021-08304-5 ◽

2021 ◽

Author(s):

Yassin Eddahchouri ◽

◽

Frans van Workum ◽

Frits J. H. van den Wildenberg ◽

Mark I. van Berge Henegouwen ◽

...

Keyword(s):

Minimally Invasive ◽

Expert Panel ◽

Minimally Invasive Esophagectomy ◽

Round Table ◽

Round Table Discussion ◽

Ivor Lewis ◽

Delphi Methodology ◽

Invasive Esophagectomy ◽

European Consensus ◽

Mckeown Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure with a long learning curve, which is associated with increased morbidity and mortality. To master MIE, training in essential steps is crucial. Yet, no consensus on essential steps of MIE is available. The aim of this study was to achieve expert consensus on essential steps in Ivor Lewis and McKeown MIE through Delphi methodology. Methods Based on expert opinion and peer-reviewed literature, essential steps were defined for Ivor Lewis (IL) and McKeown (McK) MIE. In a round table discussion, experts finalized the lists of steps and an online Delphi questionnaire was sent to an international expert panel (7 European countries) of minimally invasive upper GI surgeons. Based on replies and comments, steps were adjusted and rephrased and sent in iterative fashion until consensus was achieved. Results Two Delphi rounds were conducted and response rates were 74% (23 out of 31 experts) for the first and 81% (27 out of 33 experts) for the second round. Consensus was achieved on 106 essential steps for both the IL and McK approach. Cronbach’s alpha in the first round was 0.78 (IL) and 0.78 (McK) and in the second round 0.92 (IL) and 0.88 (McK). Conclusions Consensus among European experts was achieved on essential surgical steps for both Ivor Lewis and McKeown minimally invasive esophagectomy.

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