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

Abstract

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.