An automatically contamination-avoiding technique for intracorporeal esophagojejunostomy using a transorally inserted anvil during laparoscopic total gastrectomy for gastric cancer.

Yan-Feng Hu,Hao Liu,Xin Lu,Zhen-Wei Deng,Da Wang,Tao Chen,Guo-Xin Li,Ting-Yu Mou,Jiang Yu,Tian Lin

doi:10.1186/s12957-015-0563-0

Abstract

BackgroundIntracorporeal Roux-en-Y esophagojejunostomy during laparoscopic total gastrectomy for gastric cancer remains a challenging manipulation due to the uncontrolled direction of the jejunal side or unintended embedded tissues, although several methods have been introduced. In this study, we simplified the procedure based on a surgical string fixing technique using a transorally inserted anvil (OrVil™; Covidien Ltd., Mansfield, MA, USA).MethodsFrom March 2012 to September 2013, 14 consecutive patients underwent simplified intracorporeal Roux-en-Y esophagojejunostomy using OrVil™ during laparoscopic total gastrectomy for gastric cancer at our hospital. Clinicopathologic characteristics and surgical outcomes of these patients were retrospectively analyzed.ResultsAll of the procedures were successful completed with no complication or conversion to open surgery. The mean overall operative time was 193.8 ± 41.8 min, whereas the mean reconstruction time was 32.6 ± 4.6 min. The mean estimated blood loss was 105.7 ± 65.4 ml. The mean diameter of anastomosis measured by upper gastrointestinal contrast X-ray test at 1 month after operation was 2.3 cm. During a median follow-up period of 12 months, neither local recurrence nor anastomosis-related morbidity was observed.ConclusionsOur preliminary results suggested that this automatically contamination-avoiding technique based on a surgical-string-fixing strategy using OrVil™ during laparoscopic total gastrectomy for gastric cancer might be feasible and safe and provide a simple solution for intracorporeal Roux-en-Y esophagojejunostomy.

Highlights

Intracorporeal Roux-en-Y esophagojejunostomy during laparoscopic total gastrectomy for gastric cancer remains a challenging manipulation due to the uncontrolled direction of the jejunal side or unintended embedded tissues, several methods have been introduced
The difficulties in terms of laparoscopically creating a purse-string suture and fixing the anvil at the esophageal stump always exist, increasing the potential risk of complications and prolonging the operation time. To avoid these difficulties mentioned above, a transorally inserted anvil (OrVilTM; Covidien Ltd., Mansfield, MA, USA) device has been developed in recent years [5,6,7]
The mean diameter of anastomosis measured by upper gastrointestinal contrast X-ray test at 1 month after operation was 2.3 cm (Figure 6)

Summary

Introduction

Intracorporeal Roux-en-Y esophagojejunostomy during laparoscopic total gastrectomy for gastric cancer remains a challenging manipulation due to the uncontrolled direction of the jejunal side or unintended embedded tissues, several methods have been introduced. To overcome the surgical difficulty and maximize the clinical benefits from minimally invasive surgery in the management of patients with proximal gastric cancer, intracorporeal esophagojejunostomy, including either circular or linear anastomosis, has been introduced. To avoid these difficulties mentioned above, a transorally inserted anvil (OrVilTM; Covidien Ltd., Mansfield, MA, USA) device has been developed in recent years [5,6,7]. We attempted to simplify this technique by adopting several tips with inexpensive and available devices and evaluated its surgical safety in the present study

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Results

Discussion

Conclusion