Skip to main content


Log in

Application of the transorally inserted anvil (OrVil™) after laparoscopy-assisted total gastrectomy

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript



Laparoscopy-assisted total gastrectomy (LATG) is not a commonly performed procedure due to the surgical difficulty associated with reconstruction. Although various reconstruction methods have been reported, a standard technique has not yet been established. In this study, we compared the short-term outcomes of LATG reconstructed by mini-laparotomy and by the newly developed transorally inserted anvil (OrVil™).


From April 2006, a series of 45 patients underwent LATG. Of these, 15 were reconstructed by mini-laparotomy and 30 by OrVil™. Short-term outcomes were compared between the two groups.


Operation time was significantly shortened and intraoperative blood loss significantly reduced by the use of OrVil™. The postoperative course, including morbidity, did not differ between the two groups.


LATG using OrVil™ for the treatment of early gastric cancer is a technically feasible surgical procedure with sufficient lymph node dissection, satisfactory early recovery, and acceptable morbidity. It will be necessary to perform this novel technique in a large number of patients to confirm its feasibility.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Kitano S, Shimoda K, Miyahara M, Shiraishi N, Bandoh T, Yoshida T, Shuto K, Kobayashi M (1995) Laparoscopic approaches in the management of patients with early gastric carcinomas. Surg Laparosc Endosc 5:359–362

    PubMed  CAS  Google Scholar 

  2. Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open vs laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19:1172–1176

    Article  PubMed  CAS  Google Scholar 

  3. Tanimura S, Higashino M, Fukunaga Y, Kishida S, Nishikawa M, Ogata A, Osugi H (2005) Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Endosc 19:1177–1181

    Article  PubMed  CAS  Google Scholar 

  4. Tan YK, Fielding JW (2006) Early diagnosis of early gastric cancer. Eur J Gastroenterol Hepatol 18:821–829

    Article  PubMed  Google Scholar 

  5. Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer. Surg Endosc 19:168–173

    Article  PubMed  Google Scholar 

  6. Kawamura H, Okada K, Isizu H, Masuko H, Yamagami H, Honma S, Ueki S, Noguchi K, Kondo Y (2008) Laparoscopic gastrectomy for early gastric cancer targeting as a less invasive procedure. Surg Endosc 22:81–85

    Article  PubMed  Google Scholar 

  7. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72

    Article  PubMed  Google Scholar 

  8. Usui S, Ito K, Hiranuma S, Takiguchi N, Matsumoto A, Iwai T (2007) Hand-assisted laparoscopic esophagojejunostomy using newly developed purse-string suture instrument “Endo-PSI”. Surg Laparosc Endosc Percutan Tech 17:107–110

    Article  PubMed  Google Scholar 

  9. Uyama I, Sugioka A, Matsui H, Fujita J, Komori Y, Hatakawa Y, Hasumi A (2001) Laparoscopic side-to-side esophagogastrostomy using a linear stapler after proximal gastrectomy. Gastric Cancer 4:98–102

    Article  PubMed  CAS  Google Scholar 

  10. Jeong O, Park YK (2009) Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil™) after laparoscopic total gastrectomy. Surg Endosc. doi: 10.1007/s00464-009-0461-z, April 3 2009

  11. Japanese Gastric Cancer Association (1998) Japanese Classification of Gastric Carcinoma—2nd English edition. Gastric Cancer 1:10–24

    Article  PubMed  Google Scholar 

  12. Sakuramoto S, Kikuchi S, Futawatari N, Katada N, Moriya H, Hirai K, Yamashita K, Watanabe M (2009) Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy. Surg Endosc. doi:10.1007/s00464-009-0371-0, 6 March 2009

  13. Okabe H, Satoh S, Inoue H, Kondo M, Kawamura J, Nomura A, Nagayama S, Hasegawa S, Itami A, Watanabe G, Sakai Y (2007) Esophagojejunostomy through minilaparotomy after laparoscopic total gastrectomy. Gastric Cancer 10:176–180

    Article  PubMed  Google Scholar 

  14. Mochiki E, Toyomasu Y, Ogata K, Andoh H, Ohno T, Aihara R, Asao T, Kuwano H (2008) Laparoscopically assisted total gastrectomy with lymph node dissection for upper and middle gastric cancer. Surg Endosc 22:1997–2002

    Article  PubMed  Google Scholar 

  15. Pugliese R, Maggioni D, Sansonna F, Scandroglio I, Ferrari GC, Di Lernia S, Costanzi A, Pauna J, de Martini P (2007) Total and subtotal laparoscopic gastrectomy for adenocarcinoma. Surg Endosc 21:21–27

    Article  PubMed  CAS  Google Scholar 

  16. Tanimura S, Higashino M, Fukunaga Y, Kishida S, Ogata A, Fujiwara Y, Osugi H (2007) Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer. Br J Surg 94:204–207

    Article  PubMed  CAS  Google Scholar 

  17. Chavarriaga LF, Cook MW, White B, Jeansonne L, Gletsu N, Parker CB, Sweeney J, Davis SS, Lin E (2010) Transoral technique for gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass (LRYGBP) can accelerate learning curve and reduce cost. Obes Surg 20:846–850

    Article  PubMed  Google Scholar 

Download references


Drs. Kunisaki, Makino, Oshima, Fujii, Kimura, Takagawa, Kosaka, Akiyama, and Endo have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Chikara Kunisaki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kunisaki, C., Makino, H., Oshima, T. et al. Application of the transorally inserted anvil (OrVil™) after laparoscopy-assisted total gastrectomy. Surg Endosc 25, 1300–1305 (2011).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: