Journal of Gastrointestinal Surgery

, Volume 14, Issue 10, pp 1613–1618 | Cite as

Technique of Minimally Invasive Ivor Lewis Esophagogastrectomy with Intrathoracic Stapled Side-to-Side Anastomosis

  • Kfir Ben-David
  • George A. Sarosi
  • Juan C. Cendan
  • Steven N. Hochwald
How I do it

Abstract

Objective

An intrathoracic linear stapled side-to-side anastomosis for gastroesophageal junction malignancy is feasible, results in low leak rates and less stenosis.

Design

Retrospective case series.

Setting

University tertiary care center.

Patients

Between March 2008 and January 2009, six patients with gastroesophageal junction malignancy undergoing minimally invasive esophagectomy with an intrathoracic linear stapled side-to-side anastomosis were identified and their clinicopathological data analyzed.

Main Outcome Measures

Technique of a 6-cm side-to-side stapled intrathoracic esophagogastric anastomosis.

Results

Six patients underwent a minimally invasive esophagectomy with a side-to-side stapled intrathoracic esophagogastric anastomosis. Median age was 61.5 years. All patients had gastroesophageal junction adenocarcinoma and completed neoadjuvant chemoradiation therapy. The median operative time was 360 min. No patient received a blood transfusion. The 30-day mortality was 0. The median length of hospital stay was 8 days. The median number of nodes harvested was 18. At a median follow-up of 9 months, all patients were alive. There have been no anastomotic strictures to date.

Conclusion

A 6-cm side-to-side stapled intrathoracic esophagogastric anastomosis is feasible and is associated with a low anastomotic leak rate.

Keywords

Minimally invasive esophagectomy Intrathoracic anastomosis 

References

  1. 1.
    DePaula AL, Hashiba K, Ferreira EA, de Paula RA, Grecco E. Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc 1995;5:1-5.PubMedGoogle Scholar
  2. 2.
    Luketich JD, Nguyen NT, Weigel T, Ferson P, Keenan R, Schauer P. Minimally invasive approach to esophagectomy. JSLS 1998;2:243-247.PubMedGoogle Scholar
  3. 3.
    Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238:486-494.PubMedGoogle Scholar
  4. 4.
    Bizekis C, Kent MS, Luketich JD, Buenaventura PO, Landreneau RJ, Schuchert MJ, Alvelo-Rivera M. Initial experience with minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg 2006;82:402-406.CrossRefPubMedGoogle Scholar
  5. 5.
    Nguyen NT, Hinojosa MW, Smith BR, Chang KJ, Gray J, Hoyt D. Minimally Invasive Esophagectomy, Lessons Learned From 104 Operations. Ann Surg 2008;248(6):1081-1091CrossRefPubMedGoogle Scholar
  6. 6.
    Benzoni E, Bresadola V, Terrosu G, Uzzau A, Cedolini C, Intini S, Noce L, Bresadola F. Minimally invasive esophagectomy: a comparative study of transhiatal laparoscopic approach versus laparoscopic right transthoracic esophagectomy. Surg Laparosc Endosc Percutan Tech 2008;18:178-187.CrossRefPubMedGoogle Scholar
  7. 7.
    Bernabe KQ, Bolton JS, Richardson WS. Laparoscopic hand-assisted versus open transhiatal esophagectomy: a case-control study. Surg Endosc 2005;19:334-337.CrossRefPubMedGoogle Scholar
  8. 8.
    Bintintan VV, Mehrabi A, Fonouni H, Esmaeilzadeh M, Muller-Stich BP, Funariu G, Ciuce C, Gutt CN. Feasibility of a high intrathoracic esophagogastric anastomosis without thoracic access after laparoscopic-assisted transhiatal esophagectomy: a pilot experimental study. Surg Innov 2009;16:228-236.CrossRefPubMedGoogle Scholar
  9. 9.
    Braghetto I, Csendes A, Cardemil G, Burdiles P, Korn O, Valladares H. Open transthoracic or transhiatal esophagectomy versus minimally invasive esophagectomy in terms of morbidity, mortality and survival. Surg Endosc 2006;20:1681-1686.CrossRefPubMedGoogle Scholar
  10. 10.
    Dapri G, Himpens J, Cadiere GB. Robot-assisted thoracoscopic esophagectomy with the patient in the prone position. J Laparoendosc Adv Surg Tech A 2006;16:278-285.CrossRefPubMedGoogle Scholar
  11. 11.
    Fabian T, McKelvey AA, Kent MS, Federico JA. Prone thoracoscopic esophageal mobilization for minimally invasive esophagectomy. Surg Endosc 2007;21:1667-1670.CrossRefPubMedGoogle Scholar
  12. 12.
    Gerhart CD. Hand-assisted laparoscopic transhiatal esophagectomy using the dexterity pneumo sleeve. JSLS 1998;2:295-298.PubMedGoogle Scholar
  13. 13.
    Verhage RJ, Hazebroek EJ, Boone J, Van Hillegersberg R. Minimally invasive surgery compared to open procedures in esophagectomy for cancer: a systematic review of the literature. Minerva Chir 2009;64:135-146.PubMedGoogle Scholar
  14. 14.
    Horgan S, Berger RA, Elli EF, Espat NJ. Robotic-assisted minimally invasive transhiatal esophagectomy. Am Surg 2003;69:624-626.PubMedGoogle Scholar
  15. 15.
    Zhou J, Chen H, Lu JJ, Xiang J, Zhang Y, Hu H, Zhou X, Luo X, Yang F, Tam J. Application of a modified McKeown procedure (thoracoscopic esophageal mobilization three-incision esophagectomy) in esophageal cancer surgery: initial experience with 30 cases. Dis Esophagus 2009;22:687-693.CrossRefPubMedGoogle Scholar
  16. 16.
    Behzadi A, Nichols FC, Cassivi SD, Deschamps C, Allen MS, Pairolero PC. Esophagogastrectomy: the influence of stapled versus hand-sewn anastomosis on outcome. J Gastrointest Surg 2005;9:1031-1040CrossRefPubMedGoogle Scholar
  17. 17.
    Cassivi SD. Leaks, strictures, and necrosis: a review of anastomotic complications following esophagectomy. Semin Thorac Cardiovasc Surg 2004;16:124-132.CrossRefPubMedGoogle Scholar
  18. 18.
    McLarty AJ, Deschamps C, Trastek VF, Allen MS, Pairolero PC, Harmsen WS. Esophageal resection for cancer of the esophagus: long-term function and quality of life. Ann Thorac Surg 1997;63:1568-1572.CrossRefPubMedGoogle Scholar
  19. 19.
    Headrick JR, Nichols FC, 3rd, Miller DL, Allen MS, Trastek VF, Deschamps C, Schleck CD, Thompson AM, Pairolero PC. High-grade esophageal dysplasia: long-term survival and quality of life after esophagectomy. Ann Thorac Surg 2002;73:1697-1702.CrossRefPubMedGoogle Scholar
  20. 20.
    Sanders G, Borie F, Husson E, Blanc PM, Di Mauro G, Claus C, Millat B. Minimally invasive transhiatal esophagectomy: lessons learned. Surg Endosc 2007;21:1190-1193.CrossRefPubMedGoogle Scholar
  21. 21.
    Santos RS, Raftopoulos Y, Singh D, DeHoyos A, Fernando HC, Keenan RJ, Luketich JD, Landreneau RJ. Utility of total mechanical stapled cervical esophagogastric anastomosis after esophagectomy: a comparison to conventional anastomotic techniques. Surgery 2004;136:917-925.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Kfir Ben-David
    • 1
  • George A. Sarosi
    • 1
  • Juan C. Cendan
    • 1
  • Steven N. Hochwald
    • 1
  1. 1.Department of SurgeryUniversity of Florida College of MedicineGainesvilleUSA

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