Novel Intracorporeal Esophagojejunostomy Using Linear Staplers During Laparoscopic Total Gastrectomy: π-Shaped Esophagojejunostomy, 3-in-1 Technique

Kwon, In Gyu; Son, Young-Gil; Ryu, Seung Wan

doi:10.1016/j.jamcollsurg.2016.06.011

Cited by 22 publications

(23 citation statements)

References 16 publications

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“…In addition, TLG in intracorporeal anastomosis had the advantages of high safety, less adhesion, rapid recovery, and small scars (29,30). At present, the related literature (9)(10)(11)(12)(13) reports that esophagojejunostomy is mainly performed with circular and linear staplers. In fact, a variety of techniques for esophagojejunostomy have emerged in recent years, but none of them was considered as the standard technique (31).…”

Section: Discussionmentioning

confidence: 99%

“…Currently, relevant literature (9)(10)(11)(12)(13) reports that esophagojejunostomy is mainly performed with circular and linear staplers. The former mainly includes the transorally inserted anvil (OrVil TM ), reverse puncture device (RPD), and purse-string suture method; the latter mainly includes functional end-to-end (FETE), overlap anastomosis, π-shaped esophagojejunostomy and semi-end-to-end anastomosis.…”

Section: Introductionmentioning

confidence: 99%

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Esophageal Suspension Method for Hand-Sewn Esophagojejunostomy After Totally Laparoscopic Total Gastrectomy: A Simple, Safe, and Feasible Suturing Technique

et al. 2020

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Background: Totally laparoscopic total gastrectomy (TLTG) not only is difficult to operate but also has high technical requirements and a long learning curve. Therefore, it has not been widely carried out yet, and esophagojejunostomy is one of its difficulties. Relevant studies have shown that intracorporeal hand-sewn esophagojejunostomy is safe, feasible and low-cost, but it is complicated and time-consuming and requires a high-suture technique. This study introduces a simple, safe and feasible hand-sewn technique.Methods: The clinical data of 32 patients with the esophageal suspension method for hand-sewn esophagojejunostomy (suspension group) after TLTG were collected from February 2018 to June 2019. During the same period, 32 patients with traditional hand-sewn esophagojejunostomy (traditional group) after TLTG were used as the control group.Results: The operative time, anastomosis time, exhaust time and hospitalization time of the suspension group were shorter than those of the traditional group. The intraoperative blood loss in the suspension group was less than that in the traditional group. There were no postoperative complications associated with the suspension group.Conclusion: For those who have some experience in laparoscopic suture technique, the esophageal suspension method for hand-sewn esophagojejunostomy after TLTG is a simple, safe, and feasible suture technique.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Esophageal Suspension Method for Hand-Sewn Esophagojejunostomy After Totally Laparoscopic Total Gastrectomy: A Simple, Safe, and Feasible Suturing Technique

et al. 2020

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“…All patients were histologically confirmed. RATG was performed followed by the new π -shaped EJS anastomosis technique using a linear stapler [27], and the short-term operative outcomes were recorded. The primary assessments included the reconstruction type, proximal resection margin, distal resection margin, number of lymph nodes retrieved, estimated blood loss, operative complications, anastomosis time, surgery duration, postoperative first flatus, postoperative hospital stay, and the mortality and morbidity during the first 60 days after the surgery.…”

Section: Methodsmentioning

confidence: 99%

“…We used the Da Vinci robotic system to perform a 3-in-1 procedure for esophagojejunostomy using a linear stapler during total gastrectomy, known as a π -shaped esophagojejunostomy, which was recently introduced [27]. This was proven to overcome the drawbacks of total laparoscopic GI surgeries in contrast to the previous method, for which the reconstruction of the gastrointestinal tract required a 10–15-cm long incision in the epigastric region [28–30].…”

Section: Introductionmentioning

confidence: 99%

Robotic total gastrectomy with π-shaped esophagojejunostomy using a linear stapler as a novel technique

Zhang

Khaliq

et al. 2018

World J Surg Onc

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ObjectiveTo evaluate the intraoperative and short-term postoperative outcomes of a novel robotic intracorporeal π-shaped esophagojejunostomy (EJS) after D2 total gastrectomy (TG) using the Da Vinci robotic surgical system for intracorporeal anastomosis after TG.BackgroundIntracorporeal π-shaped EJS, using a linear stapler, was recently reported for laparoscopic total gastrectomy in patients with gastric cancer. However, robotic intracorporeal π-shaped EJS using a linear stapler has not been reported. This report aimed to describe the use of a novel technique for π-shaped EJS using the Da Vinci robotic system.MethodsRobotic intracorporeal π-shaped esophagojejunostomy after total gastrectomy was performed in 11 consecutive patients diagnosed with early gastric cancer, and their perioperative outcomes were analyzed.ResultsAll the operations were successful without conversion to open or laparoscopic surgery and postoperative complications. The total number of patients was 11 (7 males and 4 females). The mean age of the patients was 63.36 ± 10.56 years old. Seven patients were diagnosed with cardia cancer, 3 patients were diagnosed with gastric body cancer, and 1 patient was diagnosed with gastric antrum cancer. The patients’ mean proximal resection margin was 3.18 ± 1.17 cm, the distal resection margin was 6.18 ± 1.40 cm, the mean length of the incision was 4.55 ± 0.69 cm, the mean operative time was 287.27 ± 30.69 min, the mean day of first flatus was 3.27 ± 0.79 days, the mean day of the start of diet was 2.91 ± 0.94 days, the mean postoperative hospital stay was 11.45 ± 5.13 days, and the mean operative blood loss was 47.27 ± 31.33 ml. No complications were observed during anastomosis, and the median anastomosis time was 19.5 min. The mean number of lymph node dissections was 17.91 ± 4.59, the mean number of positive lymph nodes was 0.45 ± 0.69, all patients were diagnosed with stage I–II gastric cancer, and the mean maximum diameter of the tumor was 2.67 ± 1.30 cm. All the patients had a smooth hospital discharge.ConclusionA novel robotic gastrectomy with intracorporeal π-shaped EJS for esophagojejunal anastomosis described and shows acceptable resulted. This technique has the potential to offer better short-term surgical outcomes and overcomes the drawbacks of laparoscopy with a decreased risk of complications during and after surgery.

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“…[6] To date, there is still no standard esophagojejunostomy anastomosis method for TLTG using linear staplers. Ryu et al [7] rst reported πshaped esophagojejunostomy, a simple procedure even for unexperienced surgeons. This method allows an adequate operative visualization and avoids incomplete stapling while closing the common opening, which is considered to be the most challenging procedure in laparoscopic anastomosis.…”

Section: Introductionmentioning

confidence: 99%

Modified π-shaped Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy: a Report of 40 Consecutive Cases From a Single Center

Jin¹,

Xu²,

Liu³

et al. 2021

Preprint

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Background: Intracorporeal esophagojejunostomy remains a challenging technique in totally laparoscopic total gastrectomy (TLTG) without established standard anastomosis method. π-shaped esophagojejunostomy in TLTG was reported to be safe and feasible. Therefore, this study aimed to depict our modified π-shaped esophagojejunostomy in TLTG and evaluate its short-term surgical outcomes.Methods: From April 2018 to October 2019, 40 patients with gastric cancer who underwent TLTG by the same surgeon with modified π-shaped esophagojejunostomy were enrolled. Clinicopathologic data including age, gender, body mass index, American Society of Anesthesiologists score, tumor size, tumor location, depth of tumor invasion, number of harvested lymph nodes, nodal metastasis and TNM stage, operative time, estimated blood loss, time to resume diet, postoperative hospital stays, complication, and mortality were collected and retrospectively analyzed.Results: The mean operative time and estimated blood loss were 264.6 ± 56.9 min and 68.5 ± 53.3 mL, respectively. Postoperative flatus occurred at 4.6 ± 1.7 days. The mean time to resume diet was 7.4 ± 1.7 days postoperatively. One patient was diagnosed with anastomotic leakage and managed with conservative therapy. Pleural effusion, occurring in 4 (10%) patients, was the most common complication. One patient experienced intra-abdominal bleeding requiring reoperation. Other complications were atrial fibrillation and wound infection. No mortality occurred during the 6-month follow-up.Conclusions: Modified π-shaped esophagojejunostomy is a safe and feasible method for intracorporeal anastomosis in TLTG, which showed favorable surgical outcomes.

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Novel Intracorporeal Esophagojejunostomy Using Linear Staplers During Laparoscopic Total Gastrectomy: π-Shaped Esophagojejunostomy, 3-in-1 Technique

Cited by 22 publications

References 16 publications

Esophageal Suspension Method for Hand-Sewn Esophagojejunostomy After Totally Laparoscopic Total Gastrectomy: A Simple, Safe, and Feasible Suturing Technique

Esophageal Suspension Method for Hand-Sewn Esophagojejunostomy After Totally Laparoscopic Total Gastrectomy: A Simple, Safe, and Feasible Suturing Technique

Robotic total gastrectomy with π-shaped esophagojejunostomy using a linear stapler as a novel technique

Modified π-shaped Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy: a Report of 40 Consecutive Cases From a Single Center

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