How to do a thoracoscopic‐assisted oesophagectomy with oesophagogastric anastomosis using a circular stapler

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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Evaluation of the Proximate-ILs® Circular Stapler

Annals of Surgery ◽

10.1097/00000658-198501000-00016 ◽

1985 ◽

Vol 201 (1) ◽

pp. 108-114 ◽

Cited By ~ 1

Author(s):

VICTOR W. FAZIO ◽

DAVID G. JAGELMAN ◽

IAN C. LAVERY ◽

B. A. McGONAGLE

Keyword(s):

Circular Stapler

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Step-by-step esophagojejunal anastomosis after intra-corporeal total gastrectomy for laparoscopic gastric cancer treatment: technique of "reverse anvil"

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202014000100017 ◽

2014 ◽

Vol 27 (1) ◽

pp. 71-76 ◽

Cited By ~ 3

Author(s):

Croider Franco LACERDA ◽

Paulo Anderson BERTULUCCI ◽

Antônio Talvane Torres de OLIVEIRA

Keyword(s):

Total Gastrectomy ◽

Circular Stapler ◽

Jejunal Loop ◽

Linear Stapler ◽

Treatment Technique ◽

Esophagojejunal Anastomosis ◽

Technical Details ◽

Gastric Cancer Treatment ◽

Gastric Tubes ◽

The Moment

Background: The laparoscopic gastrectomy is a relatively new procedure due mainly to the difficulties related to lymphadenectomy and reconstruction. Until the moment, technique or device to perform the esophagojejunal anastomosis by laparoscopy is still a challenge. So, a safe, cheap and quickly performing technique is desirable to be developed. Aim : To present technique proposed by the authors with its technical details on reconstruction with "reverse anvil". Method: After total gastrectomy completed intra-corporeally, the reconstruction starts with the preparation of the intra-abdominal esophagus cross-section next to the esophagogastric transition of 50%. A graduated device is prepared using Levine gastric tubes (nº. 14 and 10), 3 cm length, connected to the anvil of the circular stapler (nº. 25) with a wire thread (2-0 or 3-0) of 10 cm, which is connected to end of this device. The whole device is introduced in reverse esophagus. The esophagus is amputated and the wire is pulled after previous transfixation in the distal esophagus and the anvil positioned. The jejunal loop is sectioned 20-30 cm from duodenojejunal angle, and the anvil put in the jejunal loop and connect previously in the esophagus. Linear stapler (blue 60 mm) is used to close the opening of the jejunal loop. Conclusion: The "reverse anvil" technique used by the authors facilitated the transit reestablishment after total gastrectomy, contributing to obviate reconstruction problems after total gastrectomy.

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