Takeuchi Hiroya, Oyama Takashi, Saikawa Yoshiro, Kitagawa Yuko
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
J Laparoendosc Adv Surg Tech A. 2012 Jan-Feb;22(1):88-92. doi: 10.1089/lap.2011.0414. Epub 2011 Dec 13.
This article describes a novel, easy, and secure thoracoscopic intrathoracic esophagogastric anastomosis procedure that uses a circular stapler with transoral placement of the anvil for patients with esophageal cancer who underwent thoracoscopic esophagectomy.
After the thoracoscopic esophagectomy, the esophagus was transected obliquely at the level of the upper posterior mediastinum using a linear stapler. The Orvil™ (Autosuture, Norwalk, CT) anvil was placed at the edge of the staple line of the esophageal stump, which was relatively at an acute angle to the stump. Next the gastric conduit was pulled through the esophageal hiatus into the right thoracic cavity. The shaft of a 25-mm circular stapler was inserted and placed into the gastric conduit from the gastrotomy. Circular stapling was undertaken in a conventional manner. The access opening on the stump of the gastric conduit was closed with a linear stapler intracorporeally.
The anastomotic procedure was completed in 20 patients. Intraoperative complications or conversions to open surgery from thoracoscopic surgery were not observed in any patient. There were no severe postoperative complications, such as anastomotic leaks or gastric conduit necrosis.
The present study revealed that our novel thoracoscopic intrathoracic esophagogastric anastomosis was technically easy and safe with minimal morbidity.
本文描述了一种新颖、简便且安全的胸腔镜下胸段食管胃吻合术，该术式采用圆形吻合器经口置入吻合器砧座，用于接受胸腔镜食管切除术的食管癌患者。
胸腔镜食管切除术后，使用直线切割吻合器在上后纵隔水平斜行切断食管。将Orvil™（自动缝合器，美国康涅狄格州诺沃克市）砧座置于食管残端吻合器钉合线边缘，该边缘与残端呈相对锐角。接着将胃管经食管裂孔拉至右侧胸腔。将25毫米圆形吻合器的杆经胃切开处插入并置入胃管内。以常规方式进行圆形吻合。胃管残端的开口在体内用直线切割吻合器关闭。
20例患者完成了吻合手术。所有患者均未观察到术中并发症或由胸腔镜手术转为开放手术的情况。没有出现严重的术后并发症，如吻合口漏或胃管坏死。
本研究表明，我们新颖的胸腔镜下胸段食管胃吻合术在技术上简便且安全，并发症发生率极低。
