Usage of “Reversal Penetrating Technique” with Ancillary Trocar in Minimally Invasive Ivor Lewis Esophagectomy

Abstract

We present a "Reversal Penetrating Technique" (RPT) to perform thoracoscopic esophagogastric anastomosis in Ivor Lewis minimally invasive esophagectomy (MIE). The safety and efficiency of this technique are evaluated. RPT was used in Ivor Lewis MIE for treating patients with distal esophageal cancer. A specific anvil set is inserted into proximal esophagus lumen to allow its prefixed Prolene suture to pierce from the inside out. Then, the suture is pulled until the anvil rod penetrates the esophageal wall. The esophageal stump and anvil placement are completed after the esophagus is transected by a linear stapler. After the circular stapler is docked with the anvil, the intrathoracic anastomosis is performed in a side-to-side manner. Since August 2012, RPT anastomosis was successfully performed in 30 consecutive patients without conversion to other anastomotic techniques or open surgery. No patient experienced anastomotic leak or gastric tube necrosis. No postoperative deaths occurred. No patient complained of remarkable dysphasia during follow-up. Twenty six patients were checked by gastroscopy, no localized recurrence or anastomotic stricture was identified. RPT is less technically challenging as it eliminates the need for sewing and trimming of esophageal remnant. This technique is safe and efficient, and is particularly suited to those who do not have access to the Orvil device when performing Ivor Lewis MIE.