Laparoscopic introduction of a center rod using a Nelaton catheter during laparoscopic esophagogastrostomy.

During laparoscopic proximal gasterctomy, the difficulty associated with the use of a circular stapler for esophagogastrectomy is not only the fixation of the anvil, but also the laparoscopic manipulation of the body of the circular stapler. We have developed a new approach to the laparoscopic introduction of the center rod using a Nelaton catheter. After transection of the esophagus, the stomach is pulled out through an umbilical minilaparotomy. The proximal gastrectomy is performed extracorporeally, and a Nelaton catheter is passed through a small incision at the lower body of the stomach and a small penetrating wound at the point of the esophagogastrostomy. The Nelaton catheter is attached to the center rod of the circular stapler. The center rod can be guided to the appropriate point laparoscopically by the Nelaton catheter. Between January 2009 and May 2010, 11 patients underwent this procedure, successfully. This technique was useful for laparoscopic proximal gastrectomy.