Emanuele L. G. Asti, MD, FACS, Luigi Bonavina, MD, FACS. IRCCS Policlinico San Donato
Laparoscopy is the first step in minimally invasive esophagectomy (MIE) for the treatment of the distal esophageal cancer.
After we perform a right thoracoscopy in a semi-prone position. In the chest, two trocars are placed in the 4th and 6th intercostal space. An antero-lateral 6 cm length incision is protected with Alexis® (Applied Medical) in the eighth space.
The video focuses on the technique of an intra-corporeal esophagogastric anastomosis.
The anvil EEA 25 stapler (Medtronic) is inserted in a horizontal esophagotomy. Attached to the sharp tip of the anvil there is a 5 cm 2-0 polypropylene suture. The anterior esophageal wall is passed from inside with a transmural reverse puncture. The esophagus is divided distally to the anvil with a 60 mm EndoGIA stapling (Medtronic). The anvil is pulled out with a gentle traction close to the stapled line and the base of the rod is reinforced with an Endoloop ligature (Ethicon). The sharp tip of the anvil is disengaged. The EEA stapler (Medtronic) is introduced into the chest cavity through the Alexis than into the gastric pull-up through a gastrotomy of the lesser curvature. We perforate the tip of the gastric tube close to the greater curvature and engage the esophageal anvil. The mechanical anastomosis is performed. After checking the doughnut, we complete the transection of the remnant gastric tube.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80332
Program Number: V213
Presentation Session: Video Loop
Presentation Type: VideoLoop