Experiences with a simple laparoscopic gastric tube construction

Wang, Bing‐Yen; Tsao, Lien Cheng; Cheng, Ching-Yuan; Lin, Ching-Hsiung; Shih, Chun‐Hsing; Liu, Chia‐Chuan

doi:10.1186/1749-8090-8-14

Cited by 5 publications

(5 citation statements)

References 7 publications

(10 reference statements)

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“…Constructing a gastric tube in the abdominal cavity has the main disadvantage of the risk of tube reversal when lifted to the thoracic cavity [3]. In 2013, Wang et al [16] strongly suggested to not separate the gastric tube and the oesophagus after gastric tube construction in the abdominal cavity during McKeown MIE. The reasons he brought up were: (i) to prevent the gastric tube and the oesophagus from separating during lifting; (ii) to avoid gastric tube angulation because the gastric tube has uniformly distributed tension during lifting and (iii) to avoid intra-abdominal suturing and knotting to reduce the difficulty of operation.…”

Section: Discussionmentioning

confidence: 99%

“…The actual ILMIE approach involves the construction of an abdominal gastric tube [5]. The main disadvantage of the abdominal construction is that a slender gastric tube has a risk of torsion when lifted to the thoracic cavity [3], as well as a risk of gastric volvulus [16]. We are able to perform an Ivor Lewis open oesophagectomy (ILOE) involving the construction of a gastric tube in the thoracic cavity, using transthoracic hand-made purse suture to fix the stapling anvil and performing the anastomosis using a circular stapler.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Technical and early outcomes of Ivor Lewis minimally invasive oesophagectomy for gastric tube construction in the thoracic cavity

Zhu

Liang

et al. 2013

Interactive CardioVascular and Thoracic Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Technical and early outcomes of Ivor Lewis minimally invasive oesophagectomy for gastric tube construction in the thoracic cavity

Zhu

Liang

et al. 2013

Interactive CardioVascular and Thoracic Surgery

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“…Additional potential shortcomings of a laparoscopic conduit preparation include risk of torsion of a slender conduit on delivery from the abdomen into the chest, risk of separation of conduit from the specimen upon delivery, inability to palpate the gastroepiploic arcade, and trauma from handling of the stomach with graspers. 1,10,13 Minimally invasive Ivor-Lewis esophagectomy with transthoracic extracorporeal gastric conduit preparation has the potential to mitigate the shortcomings of laparoscopic conduit preparation. This technique of transthoracic conduit preparation was developed at our institution in response to a challenging case of distal esophageal cancer.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, transthoracic extracorporeal gastric conduit creation mitigates the risk of torsion of a slender gastric tube laparoscopically constructed when being delivered into the thoracic cavity. 13,14 This alternative technical approach allows for a direct translation of open esophagectomy skills to the minimally invasive approach as it pertains to the evaluation of the stomach after mobilization and the preparation of the gastric conduit. It may also be helpful in a transition from open to totally minimally invasive esophagectomy.…”

Section: Discussionmentioning

confidence: 99%

Transthoracic Extracorporeal Gastric Conduit Preparation for Minimally Invasive Ivor-Lewis Esophagectomy

McGuire

Gilbert

2015

Innovations�(Phila)

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Objective During totally minimally invasive esophagectomy (MIE), the gastric conduit is typically constructed via laparoscopy. Trauma from laparoscopic instruments, inability to palpate the gastroepiploic arcade, and challenges in optimal positioning of the stomach for intra-abdominal stapling have led to the widespread use of laparotomy as part of hybrid MIE procedures. Our objective was to evaluate the safety of transthoracic extracorporeal gastric conduit preparation. We hypothesize that this alternative technique is equivalent in safety to the laparoscopic approach. Methods This is a retrospective comparison of laparoscopic and transthoracic extracorporeal gastric conduit preparation with regard to anastomotic and respiratory outcomes. Results During a 3-year period, 30 patients underwent MIE with a right intrathoracic anastomosis (extracorporeal conduit, 15; laparoscopic conduit, 15). Mean age (58.6 vs 67 years, P = 0.59), tumor location (gastroesophageal junction vs middle and lower esophageal, P = 0.27), and histology (adenocarcinoma vs other 26.7%, P = 0.68) were similar between groups. Anastomotic technique and operating surgeon were the same for all patients. Patients in the laparoscopic gastric conduit group were more likely to have undergone induction chemoradiotherapy (40% vs 80%, P = 0.030). There was no significant difference between groups with respect to anastomotic complications, including anastomotic leak and anastomotic stricture (20% vs 13.3%, P = 0.70). Transthoracic gastric conduit preparation was not associated with increased respiratory complications (8% vs 12%, P = 0.09). Conclusions Transthoracic gastric conduit preparation is a simple, minimally invasive alternative laparotomy for gastric conduit preparation during MIE. No additional incision is required. The technique may help surgeons overcome shortcomings of the laparoscopic approach without impacting perioperative risk.

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“…Instead of the gastric pull-up, a narrow tube-like gastric conduit has less food retention and a lower regurgitation rate. In the USA, Luketich et al 16 reported a method of gastric conduit formation, and in Taiwan, Wang et al 17 reported a practical and easier approach: cutting off the lesser curvature. We used a modified version of the latter.…”

Section: Gastric Conduit Formationmentioning

confidence: 99%

Robot-Assisted Minimally Invasive McKeown Esophagectomy with a FourArm Platform: Technique and Early Experience

Su¹,

Fong²,

Chen³

et al. 2015

Gastro Open J

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Objectives : We report an early, single-institution experience of Robot-Assisted Minimally Invasive McKeown Esophagectomy (RAMIME) using a four-arm platform. The technique details, rationale, complications, and pitfalls during procedure development are discussed. Methods: This was a retrospective observational study. Results: Nine of the 11 patients (median age: 57 years [range: 45-83]) had a complete (R0) resection; 10 were given induction treatment combined with chemoradiation. The median operative time was 795 min (range: 635-975). The median thoracoscopic console time was 270 min (range: 135-330). The median laparoscopic console time was 160 min (range: 150-260 min). The median blood loss was 300 cm 3 (range: 100-650), and the median length of hospital stay was 18 days (range: 14-36). The median number of lymph nodes harvested was 28 (range: 9-39). No patients were converted to open procedures. Four patients had major complications; one died of liver failure on postoperative day 16; and none had clinically significant anastomotic leaks. Conclusions: RAMIME is feasible. With good understanding of the robotic concepts and a good robotic team, RAMIME is worth trying. In addition to its well-known benefits, RAMIME permits replacing one human assistant.

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Experiences with a simple laparoscopic gastric tube construction

Cited by 5 publications

References 7 publications

Technical and early outcomes of Ivor Lewis minimally invasive oesophagectomy for gastric tube construction in the thoracic cavity

Technical and early outcomes of Ivor Lewis minimally invasive oesophagectomy for gastric tube construction in the thoracic cavity

Transthoracic Extracorporeal Gastric Conduit Preparation for Minimally Invasive Ivor-Lewis Esophagectomy

Robot-Assisted Minimally Invasive McKeown Esophagectomy with a FourArm Platform: Technique and Early Experience

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