Thoracoscopic oesophago-gastrectomy--a new technique for intra-thoracic stapling.

A new technique for performing a standard Ivor Lewis oesophagectomy avoiding the need for a conventional right thoracotomy is described. The intrathoracic dissection and the intrathoracic anastomosis, using a conventional EEA circular staple-gun, is done thoracoscopically. Eight patients with carcinoma of the gastric cardia or distal oesophagus were prepared for a palliative Ivor Lewis two-stage oesophago-gastrectomy. The details of the technique for placing the anvil of a circular staple gun in the upper oesophagus and performing the intrathoracic stapled anastomosis are described. Intrathoracic stapling under thoracoscopic video control was successful in five of the eight patients. The three other patients received 10 cm mini-thoracotomies. All patients were transferred from the intensive care unit within 24 hours and were discharged from hospital within 14 days. There were no complications and no deaths. We believe that this procedure offers many patients better palliation with reduced morbidity because the standard right thoracotomy is avoided.