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

2018 ◽  
Vol 67 (07) ◽  
pp. 578-584 ◽  
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.

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

2018 ◽  
Vol 36 (3) ◽  
pp. 218-225 ◽  
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.

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

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.

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

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.

W1516 A Safe and Reproducible Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy – the Circular Stapled Anastomosis with the Transoral Anvil.

2009 ◽  
Vol 136 (5) ◽  
pp. A-929
Author(s):  
Rene Ramirez ◽  
Jessica K. Smith ◽  
Sofia Peeva ◽  
Garrett R. Roll ◽  
Pierre Theodore ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Stapled Anastomosis ◽  
Ivor Lewis ◽  
Anastomotic Technique ◽  
Ivor Lewis Esophagectomy

Pursestring Stapled Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy

2012 ◽  
Vol 94 (6) ◽  
pp. 2133-2135 ◽  
Author(s):  
Ren-Quan Zhang ◽  
Wan-Li Xia ◽  
Ning-Ning Kang ◽  
Wei Ge ◽  
An-Guo Chen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Ivor Lewis ◽  
Anastomotic Technique ◽  
Ivor Lewis Esophagectomy

scholarly journals Side-to-side esophagogastric anastomosis for minimally invasive Ivor-Lewis esophagectomy: operative technique and short-term outcomes

2021 ◽  
Author(s):  
Manrica Fabbi ◽  
Stefano De Pascale ◽  
Filippo Ascari ◽  
Wanda Luisa Petz ◽  
Uberto Fumagalli Romario
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Anastomotic Stricture ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Open Approach ◽  
Short Term ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

AbstractTotally minimally invasive Ivor-Lewis esophagectomy (TMIIL) is associated to lower rate of post-operative complication, decreases length of hospital stay and improves quality of life compared to open approach. Nevertheless, adaptation of TMIIL still proceeds at slow pace, mainly due to the difficulty to perform the intra-thoracic anastomosis and heterogeneity of surgical techniques. We present our experience with TMIIL utilizing a stapled side-to-side anastomosis. We retrospectively evaluated 36 patients who underwent a planned TMIIL from January 2017 to September 2020. Esophagogastric anastomoses were performed using a 3-cm linear-stapled side-to-side technique. General features, operative techniques, pathology data and short-term outcomes were analyzed. The median operative time was 365 min (ranging from 240 to 480 min) with a median blood loss of 100 ml (50–1000 ml). The median overall length of stay was 13 (7–64) days and in-hospital mortality rate was 2.8%. Two patients (5.6%) had an anastomotic leak, without need for operative intervention and another patient developed an anastomotic stricture, resolved with a single endoscopic dilation. Chylothorax occurred in three patients; two of these required a surgical intervention. Pulmonary complications occurred in six patients (16.7%). Based on Comprehensive Complications Index (CCI), median values of complications were 27.9 (ranging from 20.9 to 100). The results of our study suggest that TMIIL with a 3-cm linear-stapled anastomosis seems to be safe and effective, with low rates of post-operative anastomotic leak and stricture.

Minimally invasive Ivor-Lewis esophagectomy for esophageal cancer with right aortic arch

ASVIDE ◽  
2017 ◽  
Vol 4 ◽  
pp. 46-46
Author(s):  
Jeremy Linson ◽  
Michael Latzko ◽  
Bestoun Ahmed ◽  
Ziad Awad
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Aortic Arch ◽  
Right Aortic Arch ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy
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