One‐stage Thoracoscopic Oesophagectomy: Ligature Intrathoracic Stapled Anastomosis

Abstract

Thoracoscopic oesophagectomy is usually performed in stages and intrathoracic oesophagogastric anastomosis often requires mini-thoracotomy or extension of the thoracoscopic incisions. This paper describes a new technique whereby such an operation could be completed in one stage and the need to extend the thoracoscopic incisions is obviated.

Minimally invasive intrathoracic anastomosis after Ivor Lewis esophagectomy for cancer: a review of transoral or transthoracic use of staplers

“…patientsSurgical approachPatients position a Anastomotic techniqueType of anastomosisLayersFixation of anvilWatson et al (1999) [10]2TransthoracicProne positionHandsewnEnd-to-sideSingle layerNACadiere et al (2010) [11]1TransthoracicProne positionHandsewnSide-to-endTwo layersNALee et al (1997) [12]8Transhiatal and transthoracic45° Semilateral positionCircular stapledEnd-to-sideNAPursestringNguyen et al (2001) [15]1TransthoracicLeft lateral decubitus positionCircular stapledEnd-to-sideNAHandsewn pursestringMisawa et al (2005) [17]5TransthoracicLeft lateral decubitus positionCircular stapledEnd-to-sideNAPursestringEndo-stitchBizekis et al (2006) [18]50TransthoracicLeft lateral decubitus positionCircular stapledEnd-to-sideNANRThairu et al (2007) [19]18TransthoracicProne positionCircular stapledEnd-to-sideNALinear staple gun and Z-stitchSutton et al (2002) [21]10TranshiatalSupine position…”

“…In 1997, Lee et al [12] described a one-stage right lateral thoracoscopic esophagectomy with intrathoracic stapled anastomosis in a series of eight patients with carcinoma of the lower esophagus. The operation was performed with a double-lumen tracheal tube to enable collapse of the right lung.…”

A new method for intrathoracic anastomosis in laparoscopic esophagectomy

“…7) [3]. A technique using a hand-tied (Roeder) knot also has been described [2]. If the anvil is poorly positioned or poorly secured, the anastomosis may be compromised, increasing the likelihood of a leak.…”

“…A disadvantage of the laparoscopic technique is longer surgery, particularly in the early part of a surgeonÕs ''learning curve. '' In two-stage (Ivor-Lewis) esophagectomy, a ''ratelimiting step'' is the intrathoracic esophagogastric anastomosis, performed using the circular stapler, which necessitates placement of a purse-string suture or a manually tied knot to secure the anvil in the transected proximal esophagus [2,3]. This is technically demanding and time-consuming.…”

The millennium archives: Hong Kong contribution to World literature on video‐endosurgery in the second millennium

“…42,154 Many case studies bore testimony to the efficacy of an ingenuous modification, hailed by the authors as a better alternative to the existing technique. Examples are in abundance: one-suture 109 or sutureless repair of perforated peptic ulcer, 11 thoracoscopic vagotomy, 2,107 anterior approach to the adrenals, 29,33,34 two-port technique for laparoscopic cholecystectomy, 60 suprapubic ports for appendicectomy, 122 ligature intrathoracic anastomosis, 99 one-port Tenchkoff insertion technique, 130 thoracosopic suturing of bullae, 40 argon beam pleurectomy, 158 cervicoscopic parathyroid adenectomy 111,145,157 and laparoscopic vagotomy in conjunction with gastroenterostomy 72 or pyroloplasty. 68 While many of them have now become widely adopted, some have failed to stand the test of time and have since fallen into disfavour.…”