Minimally invasive esophagectomy: anastomotic techniques

Carr, Rebecca; Molena, Daniela

doi:10.21037/aoe-20-40

Cited by 5 publications

(18 citation statements)

References 86 publications

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“…A series of technical general principles must be followed during esophagogastric anastomosis creation. First of all, appropriate apposition of esophageal submucosa with the gastric wall is necessary, since submucosa collagen mainly contributes to the integrity and the mechanical strength of the anastomosis [10].…”

Section: General Principlesmentioning

confidence: 99%

“…AL is defined as a "full-thickness gastrointestinal defect involving the esophagus, anastomosis, staple line, or conduit, irrespective of presentation or method of identification" by the Esophagectomy Complications Consensus Group and is classified into three types, depending on the management approach [9]. AL is the main cause of perioperative mortality, prolonged hospital stay, delayed oral feeding, need for reintervention, decreased overall survival, and increased risk of recurrence [10]. The steep learning curve of minimally invasive Ivor-Lewis esophagectomy is proposed as the main factor contributing to higher rates of AL, since AL incidence is limited to 4.5 % after the learning curve plateau had been achieved [4].…”

Section: Introductionmentioning

confidence: 99%

“…ΑL related complications remain the main cause of perioperative morbidity and mortality, as well as poor quality of life after open and minimally invasive esophagectomy [13]. In addition, management of an intrathoracic anastomotic leak, contrary to the cervical anastomosis, demands more aggressive interventions, such as re-operation, thoracotomy, thoracoscopic drainage, or complete gastrointestinal diversion [10].…”

Section: Introductionmentioning

confidence: 99%

“…In conclusion, intrathoracic anastomosis, although more challenging technically, is associated with a series of advantages including lower anastomotic leak rate, lower stricture formation rate, decreased nerve injury rate, and improved oncological outcomes [10]. In addition, the emergence of interventional methods for the management of anastomotic leakage have led to wide adoption of intrathoracic anastomosis [14].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the emergence of interventional methods for the management of anastomotic leakage have led to wide adoption of intrathoracic anastomosis [14]. As a result, Ivor-Lewis MIE now ranks first as the most common approach to MIE used clinically [10]. No consensus has been achieved regarding the optimal esophageal anastomotic method.…”

Section: Introductionmentioning

confidence: 99%

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Prevention of Anastomotic Leak in Minimally Invasive Esophagectomy: The Role of Anastomotic Technique and Adjuvant Surgical Strategies

Kotidis¹,

Anestiadou²

2024

Current Concepts and Controversies in Laparoscopic Surgery

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Ivor-Lewis esophagectomy is followed by a considerable anastomotic leakage rate, which is a potentially fatal complication, followed by increased morbidity and mortality. The emergence of minimally invasive surgery led to a wide variety of anastomotic techniques, three of which are mainly preferred. Hand-sewn anastomoses can be performed in an end-to-end or end-to-side manner, while stapled end-to-end or end-to-side anastomoses are conducted either as circular-stapled anastomoses using a transorally inserted anvil (Orvil™) or as hand-sewn purse-string stapled anastomoses. In addition, side-to-side esophagogastrostomy with a linear stapler is presented as a promising technique. Hybrid techniques are also reported. No consensus has been achieved upon optimal technique and the decision relies on surgeon preference and skills, cost, and length of the available conduit. Furthermore, numerous techniques have been proposed to prevent anastomotic leakage (AL), including appropriate submucosa apposition, omentoplasty of the anastomosis, wide gastric and duodenal mobilization, sufficient esophageal hiatus enlargement, gentle conduit manipulation, reinforcement of staple line, intraoperative fluorescence angiography, as well as preoperative ligation of the left gastric artery. This chapter aims to provide a critical appraisal of the various anastomotic techniques and the tips and tricks described for reducing the anastomotic leak rate during minimally invasive Ivor-Lewis esophagectomy.

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Section: General Principlesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prevention of Anastomotic Leak in Minimally Invasive Esophagectomy: The Role of Anastomotic Technique and Adjuvant Surgical Strategies

Kotidis¹,

Anestiadou²

2024

Current Concepts and Controversies in Laparoscopic Surgery

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Fully Robotic Side‐to‐Side Linear‐Stapled Anastomosis During Robotic Ivor Lewis Esophagectomy

Guerra¹,

Tribuzi²,

Giuliani³

et al. 2023

World j. surg.

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Background The adoption of robotic surgery for esophageal cancer has been expanding rapidly over the recent years. In the setting of two-field esophagectomy, different techniques exist for intrathoracic esophagogastric anastomosis, although the superiority of one over another has not been clearly demonstrated. Potential benefits in terms of anastomotic leakage and stenosis have been reported in association with a linear-stapled anastomosis as compared to the more widespread techniques of circular mechanical and hand-sewn reconstructions, however, there is still limited reported evidence on its application to robotic surgery. We here report our fully robotic technique of side-to-side, semi-mechanical anastomosis. Methods All consecutive patients undergoing fully robotic esophagectomy featuring intrathoracic side-to-side stapled anastomosis by a single surgical team were included in this analysis. Operative technique is detailed, and perioperative data are assessed. Results A total of 49 patients were included. There were no intraoperative complications and no conversion occurred. The rate of overall postoperative morbidity was 25, 14% being the relative rate of major complications. With anastomotic-related morbidity in particular, one patient developed minor anastomotic leakage. Conclusions Our experience demonstrates that a linear, side-to-side fully robotic stapled anastomosis can be created with a high technical success and minimal incidence of anastomosis-related morbidity.

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End-to-side circular stapled versus side-to-side linear stapled intrathoracic esophagogastric anastomosis following minimally invasive Ivor–Lewis esophagectomy: comparison of short-term outcomes

Fabbi

Henegouwen

Romario

et al. 2022

Langenbecks Arch Surg

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Minimally invasive esophagectomy: anastomotic techniques

Cited by 5 publications

References 86 publications

Prevention of Anastomotic Leak in Minimally Invasive Esophagectomy: The Role of Anastomotic Technique and Adjuvant Surgical Strategies

Prevention of Anastomotic Leak in Minimally Invasive Esophagectomy: The Role of Anastomotic Technique and Adjuvant Surgical Strategies

Fully Robotic Side‐to‐Side Linear‐Stapled Anastomosis During Robotic Ivor Lewis Esophagectomy

End-to-side circular stapled versus side-to-side linear stapled intrathoracic esophagogastric anastomosis following minimally invasive Ivor–Lewis esophagectomy: comparison of short-term outcomes

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