Totally mechanical linear stapled anastomosis for minimally invasive Ivor Lewis esophagectomy: Operative technique and short‐term outcomes

Abstract

Background Anastomosis is one of the important factors affecting anastomotic complications after esophagectomy, and multiple reports have compared anastomotic complications among various techniques. However, there is insufficient evidence in the literature to definitively recommend one anastomotic technique over another. Method We retrospectively evaluated 34 consecutive patients who underwent an improved totally mechanical side‐to‐side: posterior‐to‐posterior linear stapled (TM‐STS) technique for minimally invasive Ivor Lewis esophagogastric anastomosis, performed by a single surgeon between February 2015 to November 2017. The operative techniques and short‐term outcomes are analyzed in this study. Results There were no conversions to an open approach and a complete resection was achieved in all patients undergoing this improved procedure. During the first half of the series, the median operation time was 355 minutes, ranging from 257 to 480 minutes. Over the second half of this series, the median operation time was reduced to 256 minutes. There were no mortalities or serious postoperative complications. Only one patient (2.9%) had an anastomotic leak, which resolved without intervention. Another patient (2.9%) experienced transient, delayed conduit emptying which upper gastrointestinal radiography determined was due to a mechanical obstruction caused by an abnormally long gastric tube in the chest cavity. Conclusions The results of our study suggest that this improved TM‐STS technique is safe and effective for minimally invasive Ivor Lewis esophagectomy, and can be considered as one of the alternative procedure for patients with lower esophageal as well as Siewert types I/II gastroesophageal junction carcinoma.

Technical details for a robot-assisted hand-sewn esophago-gastric anastomosis during minimally invasive Ivor Lewis esophagectomy

“…Several minimally invasive esophago-gastric anastomotic techniques have been described, such as end-to-side circular stapled, end-to-side double stapling, side-to-side linear stapled, or hand-sewn anastomosis technique [4][5][6][7]. To date, however, strong evidence to support one technique over the others is still lacking; thus, the anastomotic technique usually depends on the surgeon's choice [8,9].…”

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

“…Anastomotic leakage presented in only one patient (2.9%) and was treated without intervention, while no conversion to an open approach was needed. In conclusion, the authors suggest that linear-stapled esophagogastric anastomosis is a safe and feasible option regarding short-term outcomes, although associated with a steep learning curve [25].…”

“…Furthermore, it is an easily standardized technique with a low rate of technical errors [24]. However, sufficient esophageal stump length is needed and the retention of a gastric conduit stump leads to a higher rate of ischemic anastomotic fistula formation [25]. In addition, special technical skill is required for closing sites of initial gastrostomy and esophagotomy discourages surgeons from choosing it during minimally invasive intrathoracic anastomosis formation [25].…”

Comparison of a modified one‑piece mechanical and double‑layer hand‑sewn anastomosis in McKeown esophagogastrectomy: A single‑institute retrospective study

“…Anastomosis-related complications especially anasomotic leakage is one of the most lethal comorbidies, usually resulting in pyothorax, mediastinitis, tracheal fistula, arterial fistula or septicemia, and ending up with multiple organ failure eventually. In order to achieve satisfactory esophagogastric anastomosis, much effort had been tried either to optimize the anasomotic procedure (18,19,(30)(31)(32)(33)(34)(35)(36)(37), to better off the blood flow at the anastomotic site on the grafted conduits (11,38,39), or to manage prophylactic measurements to ensure the confinement of inflammation and facilitate the healing in case of leakage (20,21). In the present study we evaluated the utility of MOMA and compared it with CDHA in cervical esophagogastric anastomosis after sub-total esophagectomy in TE-SCC patients.…”